Effect of amiodarone on warfarin therapy in patients after heart valve surgery
10.3760/cma.j.cn114015-20220321-00218
- VernacularTitle:胺碘酮对心脏瓣膜手术后华法林治疗的影响
- Author:
Zheng DING
1
;
Xiaoyuan GUAN
;
Song HU
;
Jiangshan TAN
;
Tingting YAN
;
Tingting GUO
;
Yan WU
;
Xin GAO
;
Xinxin YAN
;
Ying MENG
;
Sheng LIU
;
Yingli ZHENG
;
Lu HUA
Author Information
1. 中国医学科学院阜外医院药剂科，北京 100037
- Publication Type:Journal Article
- Keywords:
Heart valve prosthesis;
Warfarin;
Amiodarone;
Drug interactions;
International normalized ratio
- From:
Adverse Drug Reactions Journal
2022;24(7):360-364
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the effect of amiodarone on warfarin′s time in therapeutic range (TTR), daily dose of warfarin, and the occurrence of over anticoagulation in patients treated with warfarin after heart valve surgery.Methods:Demographic information and clinical information of patients taking warfarin for heart valve surgery in the anticoagulation clinic in Fuwai Hospital of Chinese Academy of Medical Sciences from November 2019 to January 2021 were collected. The patients were divided into amiodarone group and control group according to whether they were treated with amiodarone. The percentage of TTR, stable daily dose of warfarin, and the proportion of times of INR>3 in patients in the 2 groups within 90 days of outpatient follow-up were retrospectively analyzed.Results:A total of 407 patients were included in the study. There were 35 patients in the amiodarone group, including 15 males and 20 females, with a median age of 56 (49, 64) years, in which 20 (57.1%) had concomitant atrial fibrillation (AF). There were 372 patients in the control group, including 227 males and 145 females, with a median age of 55 (48, 63) years, in which 105 (28.2%) with AF. Within 90 days of discharge, the difference of percentage of TTR between the amiodarone and control groups was not significant [57.6% (44.6%, 70.6%) vs. 67.3% (52.3%, 82.3%), P=0.061], but the stable daily dose of warfarin in patients in the amiodarone group was significantly lower than that in patients in the control group [2.25 (1.72, 2.78) mg vs. 3.38 (2.59, 4.18) mg, P<0.001]. The median proportion (range) of times of INR>3 in the 1-14 days, 15-90 days after discharge and the whole follow-up period in patients in the amiodarone group were higher than those in the control group[0 (0-0.3) vs. 0(0-0.3), P=0.016; 0.08(0-0.3) vs. 0(0-1.0), P=0.002; 0.06(0-0.85) vs. 0(0-0.22), P=0.001]. Conclusions:Amiodarone can significantly increase the risk of anticoagulation in patients treated with warfarin after heart valve surgery. The daily dose of warfarin needs to be reduced in order to achieve a higher TTR and maintain the stability of anticoagulation therapy.
