Warfarin doses in the initiation phase among patients with heart valve replacement and atrial fibrillation in Hospital Pulau Pinang
The use of warfarin is essential in patients having atrial fibrillation (AF), aortic valve replacement (AVR) and mitral valve replacement (MVR). However, the use of warfarin may bring major adverse effects such as bleeding and it has dose related side effects. Due to higher incidence of bleeding...
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| Main Author: | |
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| Format: | Thesis |
| Language: | English |
| Published: |
2011
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| Subjects: | |
| Online Access: | http://eprints.usm.my/57489/1/TEOH%20CHEE%20JIA%20-%20e.pdf |
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| Summary: | The use of warfarin is essential in patients having atrial fibrillation (AF), aortic valve
replacement (AVR) and mitral valve replacement (MVR). However, the use of
warfarin may bring major adverse effects such as bleeding and it has dose related side
effects. Due to higher incidence of bleeding in initial phase of warfarin therapy and
reported fluctuation of dose in initial phase of warfarin therapy after heart valve
surgery, this study was conducted to evaluate the changes in warfarin doses among
patients after heart valve surgery and atrial fibrillation. All patients having atrial
fibrillation, aortic valve replacement and mitral valve replacement who were initiated
warfarin therapy in year 2008 till 2010 in Hospital Pulau Pinang was selected as
samples. A total of 137 patients were included for this study. Data collected included
patient’s age. race, gender, warfarin initiation date, warfarin indication, warfarin dose and INR value for 1st till 12th weeks of warfarin initiation. Statistical analysis was
performed using repeated measures ANOVA and repeated measures ANCOVA. Heart
valve replacement patients (AVR or MVR) showed increasing trend in warfarin doses
during the initial phase of warfarin therapy. This trend was not observed in Al-' patients. The dose of warfarin
warfarin initiation for AVR and MVR group (p-value <0.001) but there was no
significant difference in AF group. The dose of warfarin was significantly different
among AVR and AF patients for first 5 weeks of warfarin initiation.
Indications (p-value= 0.036) and race (p-value=0.016) were found to be significantly affecting
warfarin doses in the initial phase of warfarin therapy but not gender (p-value =0.122)
and age (p-value =0.280). Overall, the mean dose of warfarin required was lower
compared to western countries. Monitoring should be frequent for patients with heart
valve replacement during the initial 3 months period of warfarin therapy. |
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