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

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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.

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Acknowledgments

Jason Weis, Department of Cardiovascular Surgery, Mayo Clinic Hospital. Contribution: Invaluable assistance performing data collection and consulting on database management.

Funding

Funding was provided by the Mayo Clinic Hospital Department of Pharmacy.

Author information

Authors and Affiliations

  1. Department of Pharmacy, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, USA

    Logan M. Olson

  2. Department of Pharmacy, Mayo Clinic Hospital, 200 1st St SW, Rochester, MN, 55905, USA

    Andrea M. Nei, Narith N. Ou & Scott D. Nei

  3. Division of Cardiovascular Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA

    David L. Joyce

  4. Division of Biomedical Statistics and Informatics, Mayo Clinic Hospital, 200 1st St SW, Rochester, MN, 55905, USA

    Ross A. Dierkhising

Authors
  1. Logan M. Olson
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  6. Scott D. Nei
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Corresponding author

Correspondence to Logan M. Olson.

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Conflict of interest

Logan M. Olson, Andrea M. Nei, David L. Joyce, Narith N. Ou, Ross A. Dierkhising and Scott D. Nei declare that they have no conflicts of interest that might be relevant to the contents of this manuscript.

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Olson, L.M., Nei, A.M., Joyce, D.L. et al. Comparison of Warfarin Requirements in Post-cardiac Surgery Patients: Valve Replacement Versus Non-valve Replacement. Am J Cardiovasc Drugs 18, 223–229 (2018). https://doi.org/10.1007/s40256-017-0261-0

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  • DOI: https://doi.org/10.1007/s40256-017-0261-0

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