Effects of fasting on warfarin sensitivity index in patients undergoing cardiovascular surgery.
Effects of fasting on warfarin sensitivity index in patients undergoing cardiovascular surgery.
复制标题
禁食对心血管手术患者华法林敏感性指数的影响。
DOI：
10.1007/s00228-018-2592-4
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发表时间：
2019
影响因子：
2.9
通讯作者：
Matsubara K.
中科院分区：
文献类型：
--
作者：
Katada Y;Nakagawa S;Nishimura A;Sato Y;Taue H;Matsumura K;Yamazaki K;Minakata K;Yano I;Omura T;Imai S;Yonezawa A;Sato Y;Nakagawa T;Minatoya K;Matsubara K.
研究目的：华法林的药代动力学和药效学在个体间和个体内具有较大的变异性。充分了解影响华法林疗效的因素是改善华法林治疗结局的必要条件。在这项研究中，我们评估了禁食对华法林抗凝性能的影响。MethodsWe进行了一项回顾性观察研究，共涉及58例患者，接受心血管手术和随后的华法林治疗。通过测量凝血酶原时间国际标准化比值（PT-INR）评估饮食摄入对华法林抗凝特性的影响：华法林的抗凝活性表示为华法林敏感性指数（WSI）。此外，波动在WSI在研究期间获得的最大和最小WSI.ResultsThe最大PT-INR和WSI值之间的差异显着较高的患者谁是禁食的不同原因在术后期间比那些在组中没有减少饮食摄入量。禁食组最大和最小WSI之间的差异显著大于中度或未减少饮食摄入组。同时，其他指标的临床条件，包括基线Child-Pugh评分和Charlson合并症指数对WSI.ConclusionsOur结果表明，术后禁食与华法林的抗凝活性显着相关。在术后期间因不同原因禁食的患者中，可能需要更严格地控制PT-INR值和华法林调整，以避免华法林治疗中的不良反应，如出血。
PurposeWarfarin shows large inter- and intra-individual variabilities in its pharmacokinetics and pharmacodynamics. Sufficient understanding of factors affecting the response to warfarin is necessary to achieve improved outcomes for warfarin therapy. In this study, we evaluated effects of fasting on the anticoagulant properties of warfarin.MethodsWe conducted a retrospective observational study involving a total of 58 patients, who received cardiovascular surgeries and subsequent warfarin therapy. The effect of dietary intake on the anticoagulant properties with warfarin was assessed by measurement of the international normalized ratio of prothrombin time (PT-INR): the anticoagulant activities of warfarin were expressed as the warfarin sensitivity index (WSI). Additionally, fluctuations in WSI during the study period were obtained as differences between the maximum and minimum WSI.ResultsThe maximum PT-INR and WSI values were significantly higher for patients who were fasting for different reasons during the postoperative period than those in the group without reduced dietary intake. The differences between maximum and minimum WSI in the fasting group significantly increased compared with those in the groups with moderate or no reduced dietary intake. Meanwhile, effects of other markers of clinical conditions including the baseline Child-Pugh score and Charlson Comorbidity Index on WSI were not significant.ConclusionsOur results indicate that postoperative fasting was significantly associated with the anticoagulation activity of warfarin. In patients fasting for different reasons during the postoperative period, closer control of PT-INR values and warfarin adjustments may be required to avoid adverse effects such as bleeding in warfarin treatment.