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- Title
Comparison of Warfarin Requirements in Post-cardiac Surgery Patients: Valve Replacement Versus Non-valve Replacement.
- Authors
Olson, Logan M.; Nei, Andrea M.; Ou, Narith N.; Nei, Scott D.; Joyce, David L.; Dierkhising, Ross A.
- Abstract
Introduction: Anticoagulation with warfarin affects approximately 140,000 post-cardiac surgery patients every year, yet there remains limited published data in this patient population. Dosing remains highly variable due to intrinsic risk factors that plague cardiac surgery candidates and a lack of diverse literature that can be applied to those who have undergone a cardiac surgery alternative to heart valve replacement (HVR). In the present study, our aim was to compare the warfarin requirements between HVR and non-HVR patients.Methods: This was a single-center, retrospective study of post-cardiac surgery patients initiated on warfarin at Mayo Clinic Hospital, Rochester, from January 1st, 2013 to October 31st, 2016. The primary outcome was the maintenance warfarin dose at the earliest of discharge or warfarin day 10 between patients with HVR and non-HVR cardiac surgeries.Results: A total of 683 patients were assessed during the study period: 408 in the HVR group and 275 in the non-HVR group. The mean warfarin maintenance doses in the HVR and non-HVR groups were 2.55 mg [standard deviation (SD) 1.52] and 2.43 mg (SD 1.21), respectively (adjusted p = 0.65). A multivariable analysis was performed to adjust for gender, age, body mass index and drug interactions.Conclusions: This was the largest study to evaluate warfarin dose requirements in post-cardiac surgery patients and is the first to compare warfarin requirements between HVR and non-HVR patients during the immediate post-operative period. Both groups had similar warfarin requirements, which supports expanding the initial warfarin dosing recommendations of the 9th edition Chest guideline to include non-HVR patients as well as HVR patients.
- Subjects
NEW York (State); AGE distribution; DRUG interactions; HEALTH facilities; CARDIAC patients; CARDIAC surgery; PROSTHETIC heart valves; MULTIVARIATE analysis; PATIENTS; POSTOPERATIVE period; SEX distribution; SURGERY; WARFARIN; BODY mass index; DISCHARGE planning; TREATMENT effectiveness; RETROSPECTIVE studies; DESCRIPTIVE statistics
- Publication
American Journal of Cardiovascular Drugs, 2018, Vol 18, Issue 3, p223
- ISSN
1175-3277
- Publication type
Article
- DOI
10.1007/s40256-017-0261-0