Analysis of the anticoagulant effect and influencing factors of warfarin in patients after left ventricular assist device implantation guided by gene test
- VernacularTitle:基因检测指导下左心辅助装置植入术后患者华法林的抗凝效果及影响因素分析
- Author:
Ying WANG
1
,
2
;
Jin LI
1
,
2
;
Sijia ZHAO
3
;
Tao CHEN
4
;
Chengbin TANG
4
;
Jia LIU
5
Author Information
1. The Yangzhou School of Clinical Medicine of Dalian Medical University，Jiangsu Yangzhou 225001，China
2. College of Pharmacy，Dalian Medical University，Liaoning Dalian 116044，China
3. Medical College of Yangzhou University，Jiangsu Yangzhou 225009，China
4. Heart and Vascular Center，Northern Jiangsu People’s Hospital，Jiangsu Yangzhou 225001，China
5. Dept. of Pharmacy，Northern Jiangsu People’s Hospital，Jiangsu Yangzhou 225001，China
- Publication Type:Journal Article
- Keywords:
warfarin;
left ventricular assist device;
gene test;
anticoagulation;
international normalized ratio
- From:
China Pharmacy
2025;36(17):2160-2164
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To evaluate the effectiveness and safety of warfarin anticoagulation therapy guided by gene test in patients undergoing left ventricular assist device （LVAD） implantation， and to analyze the influencing factors of warfarin anticoagulation efficacy. METHODS Patients who underwent LVAD implantation at the Heart and Vascular Center of Northern Jiangsu People’s Hospital from January 2023 to October 2024 and required warfarin anticoagulant therapy were selected as the study subjects. They were divided into genetic testing group （n＝51） and empirical treatment group （n＝17） based on whether they underwent CYP2C9 and VKORC1 gene test. The gene test group was given warfarin based on the predicted dose calculated by gene test， while the empirical treatment group was given warfarin by clinical doctors based on international normalized ratio （INR） experience， all patients were given warfarin once a day. Follow-up observation was conducted for 6 months to compare the effectiveness [time in therapeutic range（TTR）， the time required to reach INR for the first time， the incidence of embolic events， the incidence of INR＜1.5 events] and safety （the incidence of major and minor bleeding events，the incidence of INR＞3.5 events） of warfarin treatment between two groups of patients. According to whether the patient’s TTR was ≥60%， they were divided into TTR≥60% group （n＝20） and TTR＜60% group （n＝48）. Univariate and multivariate binary Logistic regression analysis were used to determine the factors affecting the anticoagulant effect of warfarin in patients. RESULTS The TTR of patients in the gene test group was significantly higher than that in the empirical treatment group （P＜0.05）. The incidence of INR＜1.5 events in the gene test group was significantly lower than in the empirical treatment group （P＜0.05）. The incidence of minor bleeding events and INR＞3.5 events in the gene test group were lower than in the empirical treatment group， but the difference was not statistically significant （P＞0.05）. The results of multivariate binary Logistic regression analysis showed that gene test was an independent protective factor for warfarin anticoagulant therapy [odds ratio （OR）＝10.842， 95% confidence interval （CI）： 1.211-27.037， P＝0.033]， and the combination of statins was an independent risk factor for warfarin anticoagulant therapy [OR＝0.196， 95%CI： 0.045-0.861， P＝0.031]. CONCLUSIONS Under the guidance of gene test， warfarin anticoagulation therapy for LVAD patients after implantation can improve TTR， shorten the anticoagulation target time， and has good safety； meanwhile， it should be noted that the combination of statins may enhance the anticoagulant effect of warfarin， thereby increasing the risk of bleeding in patients.
