| Increased sensitivity to warfarin after heart valve replacement. | |
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MedLine Citation:
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PMID: 16507614 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The dosage requirement of warfarin to achieve a given international normalized ratio (INR) often varies considerably between the immediate postoperative period and long-term follow-up in patients with prosthetic heart valves, leading to INR instability. OBJECTIVE: To document the extent of warfarin sensitivity in a prospective study of patients receiving heart valve replacements. METHODS: Clinical and laboratory data regarding anticoagulation for 111 patients who received warfarin following heart valve replacement were collected during their hospital stay (induction period) and between 1 and 3 months after surgery (follow-up period). RESULTS: Mean patient age was 65.39 +/- 10.55 years (range 29-85), with 66 men. The mean INR value during the follow-up period was, on average, 0.21 higher than the induction period (2.81 +/- 0.5 vs 2.6 +/- 0.6; p = 0.007). The mean follow-up warfarin dose was 1.54 mg higher than the mean induction warfarin dose (5.09 +/- 2.03 vs 3.55 +/- 1.94 mg; p < 0.001). The warfarin dose index, which indicates relative sensitivity of warfarin, decreased from 1.16 to 0.65 (p < 0.001). Although the INR values during the induction and follow-up periods were similar, the dose requirement in the follow-up period was, on average, 43% higher than that of the induction period. CONCLUSIONS: Immediately after heart valve replacement, patients are more sensitive to warfarin and should receive a lower warfarin dose during the initial phase of oral anticoagulation treatment. This enhanced sensitivity decreases with time. Patients require frequent monitoring and are likely to need an increase in the warfarin dose to avoid insufficient anticoagulation during the early follow-up period. |
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Authors:
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Mesbah Rahman; Taha M BinEsmael; Nicola Payne; Eric G Butchart |
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Publication Detail:
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Type: Clinical Trial; Journal Article Date: 2006-02-28 |
Journal Detail:
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Title: The Annals of pharmacotherapy Volume: 40 ISSN: 1060-0280 ISO Abbreviation: Ann Pharmacother Publication Date: 2006 Mar |
Date Detail:
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Created Date: 2006-03-07 Completed Date: 2006-04-26 Revised Date: 2006-10-13 |
Medline Journal Info:
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Nlm Unique ID: 9203131 Medline TA: Ann Pharmacother Country: United States |
Other Details:
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Languages: eng Pagination: 397-401 Citation Subset: IM |
Affiliation:
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Department of Cardiothoracic Surgery, University Hospital Wales, Cardiff, UK. mesbah@hotmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Anticoagulants / adverse effects* Female Follow-Up Studies Heart Valve Prosthesis Implantation* Humans International Normalized Ratio Male Middle Aged Partial Thromboplastin Time Postoperative Complications / blood*, chemically induced* Prospective Studies Warfarin / adverse effects* |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 81-81-2/Warfarin |
| Comments/Corrections | |
Comment In:
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Ann Pharmacother. 2006 Jul-Aug;40(7-8):1476-7
[PMID:
16835315
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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