Maintenance dose of warfarin beyond time in therapeutic range for preventing vascular events.
J Neurol Sci
; 398: 69-74, 2019 Mar 15.
Article
en En
| MEDLINE
| ID: mdl-30684767
ABSTRACT
BACKGROUND:
The quality of anticoagulation is closely associated with efficacy and safety in warfarin users. Although genetic polymorphisms have been related to warfarin dosages and vascular events(VE), genetic evaluations have not been recommended for all warfarin users. The aim is to evaluate the significance of the maintenance dose of warfarin (MDW) on VE, considering the time in therapeutic range (TTR).METHODS:
This retrospective study analyzed the data of patients who received warfarin for any reasons. A total of 11,835 patients with warfarin were divided into quartiles by MDW. We assessed TTR using the Rosendaal method and VE.RESULTS:
VE occurred in 9.1% of the warfarin users. The mean TTR level was 34.0⯱â¯25.7%, and the MDW was 3.38⯱â¯1.06â¯mg per day. Patients with VE were more likely to have a lower MDW and lower TTR levels. In moderate- or well-controlled TTR status, a lower MDW was significantly related to under-controlled anticoagulation and associated with higher risks of VE. Lower MDW had a higher risk of stroke or arterial/venous thromboembolism (Q1 OR, 1.57; 95% CI 1.25 to 1.96; Q2 OR, 1.40; 95% CI 1.12 to 1.75; Q3 OR, 1.35; 95% CI 1.08 to 1.68).CONCLUSIONS:
We suggest that patients with very low MDW might be at risk when using warfarin. Therefore, we propose that patients with a very low MDW might be alternatively considered for novel oral anticoagulants rather than warfarin.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Enfermedades Vasculares
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Warfarina
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Anticoagulantes
Tipo de estudio:
Diagnostic_studies
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Observational_studies
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Risk_factors_studies
Límite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Año:
2019
Tipo del documento:
Article