Long-term treatment with warfarin in Chinese population
| Autor: | Mei-Huei Chou, Rou-Yee Chenhsu, Ming-Fang Lin, Shu-Chiung Chiang |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
0301 basic medicine
Male Pediatrics medicine.medical_specialty Time Factors medicine.drug_class Population Hemorrhage 030204 cardiovascular system & hematology Cohort Studies 03 medical and health sciences 0302 clinical medicine Asian People Risk Factors Thromboembolism medicine Humans Pharmacology (medical) Risk factor education Retrospective Studies education.field_of_study business.industry Incidence (epidemiology) Incidence Anticoagulant Warfarin Anticoagulants Retrospective cohort study Middle Aged Surgery 030104 developmental biology Female Complication business medicine.drug Cohort study Follow-Up Studies |
| Zdroj: | The Annals of pharmacotherapy. 34(12) |
| ISSN: | 1060-0280 |
| Popis: | OBJECTIVE: To estimate the incidence of and risks for bleeding and thromboembolic events after warfarin anticoagulation. We also explored the dosage and international normalized ratio (INR) among Chinese patients during long-term warfarin therapy. METHODS: The population in this retrospective study consisted of inpatients of the only medical center for northern Taipei City, whose initial course of warfarin therapy continued for more than four weeks. Enrollment began in June 1995 and ended in February 1996. Follow-up was completed in March 1998. Relevant data were collected by chart review. The rate of events was calculated using the Kaplan—Meier method, and risk factors were identified by the Cox proportional hazard model. RESULTS: During the study period, 226 patients were identified. The total follow-up time was 248.7 patient-years. Sixty-one patients (27.0%) received anticoagulation for mechanical prosthetic valve, but their duration of therapy accounted for 48.6% of the total patient-years of follow-up. The starting dosage (mean ± SD) was 3.4 ± 1.4 mg/d (range 1.3–10); the maintenance dosage was 3.1 ± 1.2 mg/d (range 1.2–7.7). There were 1060 dosing adjustments and 3398 INR measurements collected for these patients. The independent determinants of maintenance dosage were age, body weight, and indication of mechanical prosthetic valve. The INR was 1.9 ± 0.5 (range 1.0–3.7). The cumulative probabilities for hemorrhage at 12, 24, and 34 months were 24.5%, 32.3%, and 38.4%, respectively. The corresponding figures for thromboembolism were 8.5%, 10.7%, and 10.7%, respectively. Three hemorrhages were fatal. After adjusting for other patient characteristics, increasing age was the only independent risk factor identified for bleeding. CONCLUSIONS: Antithrombotic efficacy seemed to be maintained, although the mean INR was 1.9. Even so, the substantial incidence of bleeding, especially fatal bleeding, remains a concern. Low-intensity anticoagulation might be needed for Chinese patients during long-term warfarin therapy. |
| Databáze: | OpenAIRE |
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