Katie B Tellor, Steffany N Nguyen, Amanda C Bultas, Anastasia L Armbruster, Nicholas A Greenwald, Abigail M Yancey
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The primary outcome was mean total weekly dose (TWD) of warfarin based on weight classification: underweight (BMI <18 kg/m<sup>2</sup>), normal/overweight (BMI 18-29.9 kg/m<sup>2</sup>), obese (BMI 30-39.9 kg/m<sup>2</sup>), and morbidly obese (BMI ⩾ 40 kg/m<sup>2</sup>). Data were extracted from two community hospitals in reverse chronologic order during July 2015-June 2013 until both study institutions evaluated 100 patients per cohort in each BMI classification or until all patients had been evaluated within the prespecified timeframe.</p><p><strong>Results: </strong>A total of 585 patients were included in cohort A (26 underweight, 200 normal/overweight, 200 obese, 159 morbidly obese). There was a statistically significant difference in TWD as determined by one-way analysis of variance ( p < 0.05). A Tukey post hoc test revealed a statistically significantly higher TWD in morbidly obese (41.5 mg) compared with underweight (25.6 mg, p < 0.05), normal/overweight (28.8 mg, p < 0.05) and obese patients (32.4 mg, p < 0.05). In cohort B, 379 patients were evaluated (9 underweight, 166 normal/overweight, 152 obese, 52 morbidly obese). Overall, 191 patients had a therapeutic INR on discharge (88.9% underweight, 52.4% normal/overweight, 44.1% obese, 55.8% morbidly obese, p = 0.035). Of those, there was a statistically significant difference in TWD ( p = 0.021) with a higher TWD in the morbidly obese (41 mg) compared with underweight patients (24.4 mg, p = 0.017).</p><p><strong>Conclusions: </strong>Based on the results of this study, morbidly obese patients may require higher TWD to obtain and maintain a therapeutic INR.</p>","PeriodicalId":23035,"journal":{"name":"Therapeutic Advances in Cardiovascular Disease","volume":"12 8","pages":"207-216"},"PeriodicalIF":2.6000,"publicationDate":"2018-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1753944718781295","citationCount":"18","resultStr":"{\"title\":\"Evaluation of the impact of body mass index on warfarin requirements in hospitalized patients.\",\"authors\":\"Katie B Tellor, Steffany N Nguyen, Amanda C Bultas, Anastasia L Armbruster, Nicholas A Greenwald, Abigail M Yancey\",\"doi\":\"10.1177/1753944718781295\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Despite well established empiric dose adjustments for drug and disease-state interactions, the impact of body mass index (BM) on warfarin remains unclear. 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引用次数: 18
摘要
背景:尽管药物和疾病状态相互作用的剂量调整已经建立，但体重指数(BM)对华法林的影响仍不清楚。本研究的目的是评估住院患者对华法林的需求，并按BMI分层。方法:本回顾性研究包括两组患者:A组(治疗性国际标准化比率(INR)入院的患者)和B组(住院期间新开始使用华法林)。排除标准包括:年龄在18岁以下，怀孕，INR(目标2.5-3.5)，骨科手术后华法林血栓预防。主要结局是基于体重分类的华法林平均每周总剂量(TWD):体重不足(BMI 2)，正常/超重(BMI 18-29.9 kg/m2)，肥胖(BMI 30-39.9 kg/m2)和病态肥胖(BMI大于或等于40 kg/m2)。在2015年7月至2013年6月期间，数据按时间倒序从两家社区医院中提取，直到两个研究机构在每个BMI分类中对每个队列中100名患者进行评估，或者直到所有患者在预先规定的时间范围内进行评估。结果:A队列共纳入585例患者(体重过轻26例，正常/超重200例，肥胖200例，病态肥胖159例)。经单因素方差分析，两组间TWD差异有统计学意义(p < 0.05)。Tukey事后检验显示，病态肥胖患者的TWD (41.5 mg)高于体重不足患者(25.6 mg, p < 0.05)、正常/超重患者(28.8 mg, p < 0.05)和肥胖患者(32.4 mg, p < 0.05)。在队列B中，评估了379例患者(9例体重不足，166例正常/超重，152例肥胖，52例病态肥胖)。总体而言，191例患者在出院时出现治疗性INR(88.9%体重不足，52.4%正常/超重，44.1%肥胖，55.8%病态肥胖，p = 0.035)。其中，TWD差异有统计学意义(p = 0.021)，病态肥胖患者的TWD (41 mg)高于体重不足患者(24.4 mg, p = 0.017)。结论:基于本研究的结果，病态肥胖患者可能需要更高的TWD来获得和维持治疗性INR。
Evaluation of the impact of body mass index on warfarin requirements in hospitalized patients.
Background: Despite well established empiric dose adjustments for drug and disease-state interactions, the impact of body mass index (BM) on warfarin remains unclear. The objective of this study is to evaluate warfarin requirements in hospitalized patients, stratified by BMI.
Methods: This retrospective review included two cohorts of patients: cohort A (patients admitted with a therapeutic international normalized ratio (INR)) and cohort B (newly initiated on warfarin during hospitalization). Exclusion criteria included: age under 18 years, pregnancy, INR (goal 2.5-3.5), and warfarin thromboprophylaxis post orthopedic surgery. The primary outcome was mean total weekly dose (TWD) of warfarin based on weight classification: underweight (BMI <18 kg/m2), normal/overweight (BMI 18-29.9 kg/m2), obese (BMI 30-39.9 kg/m2), and morbidly obese (BMI ⩾ 40 kg/m2). Data were extracted from two community hospitals in reverse chronologic order during July 2015-June 2013 until both study institutions evaluated 100 patients per cohort in each BMI classification or until all patients had been evaluated within the prespecified timeframe.
Results: A total of 585 patients were included in cohort A (26 underweight, 200 normal/overweight, 200 obese, 159 morbidly obese). There was a statistically significant difference in TWD as determined by one-way analysis of variance ( p < 0.05). A Tukey post hoc test revealed a statistically significantly higher TWD in morbidly obese (41.5 mg) compared with underweight (25.6 mg, p < 0.05), normal/overweight (28.8 mg, p < 0.05) and obese patients (32.4 mg, p < 0.05). In cohort B, 379 patients were evaluated (9 underweight, 166 normal/overweight, 152 obese, 52 morbidly obese). Overall, 191 patients had a therapeutic INR on discharge (88.9% underweight, 52.4% normal/overweight, 44.1% obese, 55.8% morbidly obese, p = 0.035). Of those, there was a statistically significant difference in TWD ( p = 0.021) with a higher TWD in the morbidly obese (41 mg) compared with underweight patients (24.4 mg, p = 0.017).
Conclusions: Based on the results of this study, morbidly obese patients may require higher TWD to obtain and maintain a therapeutic INR.
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The journal is aimed at clinicians and researchers from the cardiovascular disease field and will be a forum for all views and reviews relating to this discipline.Topics covered will include: ·arteriosclerosis ·cardiomyopathies ·coronary artery disease ·diabetes ·heart failure ·hypertension ·metabolic syndrome ·obesity ·peripheral arterial disease ·stroke ·arrhythmias ·genetics
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