Relationship between elevated bilirubin levels and enhanced warfarin effects during biliary obstruction
Relationship between elevated bilirubin levels and enhanced warfarin effects during biliary obstruction
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DOI：
10.1007/s00228-023-03459-7
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发表时间：
2023-02
影响因子：
2.9
通讯作者：
T. Nakazawa;S. Yamazaki;M. Uchida;Takaaki Suzuki;Takako Nakamura;M. Ohtsuka;I. Ishii
中科院分区：
文献类型：
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作者：
T. Nakazawa;S. Yamazaki;M. Uchida;Takaaki Suzuki;Takako Nakamura;M. Ohtsuka;I. Ishii
目的：在使用华法林的胆道梗阻患者中，经常观察到凝血酶原时间-国际标准化比值（PT-INR）显著延长。本研究的目的是确定与PT-INR延长在胆道梗阻的患者使用华法林。MethodsAmong 44例使用华法林谁有胆道梗阻，我们回顾性调查华法林剂量和实验室数据之前和期间胆道梗阻的相关因素。结果胆道梗阻前PT-INR的中位数为1.59（IQR 1.38-1.95），梗阻期间为2.27（IQR 1.60-3.49），梗阻期间PT-INR显著延长（P< 0.001）。ΔPT-INR与总胆红素变化（ΔT-Bil;ρ= 0.692，P < 0.001）和结合胆红素变化（ΔC-Bil;ρ= 0.731，P < 0.001）呈显著正相关。ΔPT-INR与白蛋白变化呈弱负相关（ΔAlb;ρ= − 0.371，P < 0.05）。以ΔPT-INR为因变量进行多元线性回归分析时，ΔT-Bil、ΔC-Bil、ΔAlb与Δ PT-INR显著相关。如果发生胆红素水平明显升高的胆道梗阻，测量PT-INR可能导致更安全的华法林治疗。
ObjectivesA marked prolongation of the prothrombin time-international normalized ratio (PT-INR) is frequently observed during biliary obstruction in patients using warfarin. The objective of this study was to identify factors associated with PT-INR prolongation during biliary obstruction in patients using warfarin.MethodsAmong 44 patients using warfarin who had biliary obstruction, we retrospectively investigated warfarin doses and laboratory data before and during biliary obstruction. The primary outcome was the association between changes in PT-INR (ΔPT-INR) and changes in laboratory data before and during biliary obstruction.ResultsMedian PT-INR was 1.59 (IQR 1.38–1.95) before biliary obstruction and 2.27 (IQR 1.60–3.49) during biliary obstruction, indicating significant prolongation during the obstruction (P< 0.001). ΔPT-INR showed strong positive correlations with change in total bilirubin (ΔT-Bil;ρ= 0.692,P< 0.001) and change in conjugated bilirubin (ΔC-Bil;ρ= 0.731,P< 0.001). ΔPT-INR showed a weak negative correlation with the change in albumin (ΔAlb;ρ= −0.371,P< 0.05). When ΔPT-INR was used as the dependent variable in multiple linear regression analysis, ΔT-Bil, ΔC-Bil, and ΔAlb were significantly associated with ΔPT-INR.ConclusionsPT-INR was prolonged during biliary obstruction in patients using warfarin, and changes in bilirubin levels were associated with ΔPT-INR. If biliary obstruction with markedly elevated bilirubin levels occurs, measuring PT-INR could lead to safer warfarin therapy.