PMID- 26104049
OWN - NLM
STAT- MEDLINE
DCOM- 20151221
LR  - 20220321
IS  - 1542-6270 (Electronic)
IS  - 1060-0280 (Linking)
VI  - 49
IP  - 9
DP  - 2015 Sep
TI  - Changes in Warfarin Sensitivity During Decompensated Heart Failure and Chronic 
      Obstructive Pulmonary Disease.
PG  - 962-8
LID - 10.1177/1060028015590438 [doi]
AB  - BACKGROUND: Heart failure (HF) has been associated with an elevated international 
      normalized ratio (INR) in patients on warfarin. OBJECTIVES: Compare warfarin 
      sensitivity during hospital admission for HF exacerbation and chronic obstructive 
      pulmonary disease (COPD) exacerbation with admissions unrelated to HF or COPD 
      (controls) as well as during disease stability. METHODS: We conducted a 
      case-controlled observational study. Patients admitted to a tertiary teaching 
      hospital for HF exacerbation (n = 37), COPD exacerbation (n = 26), and admissions 
      unrelated to HF or COPD (controls, n = 60) were included. Warfarin sensitivity 
      (INR per daily mg dose of warfarin) at admission was compared to periods of 
      disease stability and also compared between the 3 groups. RESULTS: The increase 
      in warfarin sensitivity at admission was 94% for HF patients (P < 0.0001), 59% 
      for COPD (P = 0.003) patients, and 24% for controls (P = 0.002). HF patients with 
      New York Heart Association (NYHA) class 3 and 4 and NYHA class 1 and 2 
      experienced changes in warfarin sensitivity of 125% (P = 0.006) and 50% (P = 
      0.13) at admission. HF patients had higher warfarin sensitivity at admission 
      (mean = 1.62 [SD = 1.27]) compared to the control group (0.91 [0.52], P < 0.0001) 
      and COPD group (1.03 [0.79], P = 0.04). and required greater intervention with 
      vitamin K than controls (14% vs 0%, P = 0.007). CONCLUSION: HF and COPD patients 
      were more sensitive to warfarin during disease exacerbation, with HF exacerbation 
      having the largest impact, resulting in clinically significant management 
      implications.
CI  - (c) The Author(s) 2015.
FAU - del Campo, Michaela
AU  - del Campo M
AD  - Pharmacy, Flinders Medical Centre, Flinders Drive, Bedford Park, 5042 SA, 
      Australia.
FAU - Roberts, Greg
AU  - Roberts G
AD  - Pharmacy, Flinders Medical Centre, Flinders Drive, Bedford Park, 5042 SA, 
      Australia greg.roberts2@health.sa.gov.au.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20150623
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Anticoagulants)
RN  - 12001-79-5 (Vitamin K)
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*therapeutic use
MH  - Case-Control Studies
MH  - Disease Progression
MH  - Female
MH  - Heart Failure/*drug therapy
MH  - Hospitalization
MH  - Humans
MH  - International Normalized Ratio
MH  - Male
MH  - Pulmonary Disease, Chronic Obstructive/*drug therapy
MH  - Vitamin K/therapeutic use
MH  - Warfarin/*therapeutic use
OTO - NOTNLM
OT  - anticoagulation
OT  - chronic obstructive pulmonary disease
OT  - congestive heart failure
OT  - medication safety
OT  - warfarin
EDAT- 2015/06/25 06:00
MHDA- 2015/12/22 06:00
CRDT- 2015/06/25 06:00
PHST- 2015/06/25 06:00 [entrez]
PHST- 2015/06/25 06:00 [pubmed]
PHST- 2015/12/22 06:00 [medline]
AID - 1060028015590438 [pii]
AID - 10.1177/1060028015590438 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2015 Sep;49(9):962-8. doi: 10.1177/1060028015590438. Epub 2015 
      Jun 23.