Comparison of Warfarin Requirements in Post-cardiac Surgery Patients: Valve Replacement Versus Non-valve Replacement

Logan M. Olson, Andrea M. Nei, David L. Joyce, Narith N. Ou, Ross A. Dierkhising, Scott D. Nei

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: Anticoagulation with warfarin affects approximately 140,000 post-cardiac surgery patients every year, yet there remains limited published data in this patient population. Dosing remains highly variable due to intrinsic risk factors that plague cardiac surgery candidates and a lack of diverse literature that can be applied to those who have undergone a cardiac surgery alternative to heart valve replacement (HVR). In the present study, our aim was to compare the warfarin requirements between HVR and non-HVR patients. Methods: This was a single-center, retrospective study of post-cardiac surgery patients initiated on warfarin at Mayo Clinic Hospital, Rochester, from January 1st, 2013 to October 31st, 2016. The primary outcome was the maintenance warfarin dose at the earliest of discharge or warfarin day 10 between patients with HVR and non-HVR cardiac surgeries. Results: A total of 683 patients were assessed during the study period: 408 in the HVR group and 275 in the non-HVR group. The mean warfarin maintenance doses in the HVR and non-HVR groups were 2.55 mg [standard deviation (SD) 1.52] and 2.43 mg (SD 1.21), respectively (adjusted p = 0.65). A multivariable analysis was performed to adjust for gender, age, body mass index and drug interactions. Conclusions: This was the largest study to evaluate warfarin dose requirements in post-cardiac surgery patients and is the first to compare warfarin requirements between HVR and non-HVR patients during the immediate post-operative period. Both groups had similar warfarin requirements, which supports expanding the initial warfarin dosing recommendations of the 9th edition Chest guideline to include non-HVR patients as well as HVR patients.

Original languageEnglish (US)
Pages (from-to)223-229
Number of pages7
JournalAmerican Journal of Cardiovascular Drugs
Volume18
Issue number3
DOIs
StatePublished - Jun 1 2018
Externally publishedYes

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Warfarin
Thoracic Surgery
Heart Valves
Intrinsic Factor
Plague
Drug Interactions
Body Mass Index
Thorax
Retrospective Studies
Maintenance
Guidelines

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Comparison of Warfarin Requirements in Post-cardiac Surgery Patients : Valve Replacement Versus Non-valve Replacement. / Olson, Logan M.; Nei, Andrea M.; Joyce, David L.; Ou, Narith N.; Dierkhising, Ross A.; Nei, Scott D.

In: American Journal of Cardiovascular Drugs, Vol. 18, No. 3, 01.06.2018, p. 223-229.

Research output: Contribution to journalArticle

Olson, Logan M. ; Nei, Andrea M. ; Joyce, David L. ; Ou, Narith N. ; Dierkhising, Ross A. ; Nei, Scott D. / Comparison of Warfarin Requirements in Post-cardiac Surgery Patients : Valve Replacement Versus Non-valve Replacement. In: American Journal of Cardiovascular Drugs. 2018 ; Vol. 18, No. 3. pp. 223-229.
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