| Background&Aims:The purpose of this project is to study the relationship between warfarin maintenance dose with some demographic factors, so as to find new methods of reasonable adjustments to warfarin maintenance dose, providing new ideas for the prevention of complications of anticoagulation.Methods:1. Subjects:A total of775patients of Chinese Han Population came from Beijing Fu Wai Hospital, Guangdong Cardiovascular Institute, Qilu Hospital of Shandong University, Beijing Anzhen Hospital, Nanjing Gulou Hospital and The First Affiliated Hospital Of Zhejiang University School of Medicine. The objects of study were selected with a completely random method. All of them had achieved stable warfarin dose.2. We collected all those patients’general information, clinical data and follow-up data from the anticoagulant therapy database of chinese people after heart valve replacement. Clinical factors included gender, age, surgical approach(valve position and quantity), atrial fibrillation status, history of hypertension, history of diabetes, etc.3. The association analysis of warfarin maintenance dose with the sex, age, body weight, height, BMI(Body Mass Index), body surface area(BSA), surgical approach(valve position and quantity), atrial fibrillation status, history of hypertension, history of diabetes, smoking and drinking were performed and Step-wise regression analysis were used to analyze the contribution of those factors to warfarin maintenance dose. We analyzed the impacts of clinical factors on the intensity of anticoagulation (INR) at the same time.Results:1. Total of775patients were composed of393male and382female, they were all Han Chinese. The youngest was10years old, and the oldest was83-year-old, the average age was (50.52±11.99) years old. The mean warfarin maintenance dose of775patients was (2.77±1.06) mg/d, the minimum was0.5mg/d and the maximum was6.0mg/d. The mean maintenance dose of warfarin in female patients were less than that in male patients.2. The gender contributed to0.9%interindividual variability in warfarin maintenance dose, but INR allowable range did not differ significantly between male and female. The maintenance dose of warfarin was negatively correlated with age(r=—0.219,P<0.001), and the age contributed to4.8%interindividual variability in warfarin maintenance dose,but it had no significant effect on INR.3. The maintenance dose of warfarin was positively correlated with body surface area(r=0.321,P<0.001), and the body surface area contributed to10.3%interindividual variability in warfarin maintenance dose, but it had no significant effect on INR,either. Body weight, height and body mass index were all positively correlated with the maintenance dose of warfarin(correlation coefficients respectively0.313,0.249and0.211, P<0.001).4. Atrial fibrillation was correlated with warfarin maintenance dose, but it didn’t have a significant effect to INR. 5. Gender, age, and body surface area contributed to14.3%interindividual variability in warfarin maintenance dose. Multiple linear regression equation:warfarin maintenance dose=0.831+0.574*BSA-0.005*Age+0.051*Gender (P<0.001,R2=0.143).6. We not yet found that surgical approach, history of hypertension, history of diabetes, smoking and drinking had significant effects to warfarin maintenance dose and INR.Conclusion:1. The warfarin maintenance dose were affected by gender, age, body weight, height, Body Mass Index, body surface area and atrial fibrillation. Gender, age, body weight, height, Body Mass Index, body surface area and atrial fibrillation were all correlated with the maintenance dose of warfarin, but all of them had no significant effect on INR.2. Considering gender, age and BSA simultaneously could more accurately predict the optimal maintenance dose of warfarin.3. The study confirmed that the clinical factors such as gender, age and body surface area could only explain a part of variability of warfarin maintenance dose. Further studies are needed to investigate the effects of other factors, such as genetic, Eating habits and drugs.4. We got the linear regression equation could be used to predict the maintenance dose of warfarin for medical reference, however, the reliability need to be recognized by clinical, and thus it need to be used with caution. |
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