Acute kidney injury interacts with VKORC1 genotype on initiative warfarin dose among heart surgery recipients: a real-world research

Abstract

Patients who receive heart valve surgery need anticoagulation prophylaxis to reduce the risk of thrombosis. Warfarin often is a choice but its dosage varies due to gene and clinical factors. We aim to study, among them, if there is an interaction between acute kidney injury and two gene polymorphisms from this study. We extracted data of heart valve surgery recipients from the EHR system of a medical center. The primary outcome is about the average daily dose of warfarin, measured as an additive interaction parameter between acute kidney injury and warfarin-related gene polymorphisms. The confounders, including age, sex, BSA, comorbidities (i.e., AF, hypertension, CHF), serum albumin level, warfarin-relevant gene polymorphism (i.e., CYP2C9, VKORC1), prosthetic valve type (i.e., metal, bio), and warfarin history were controlled via a multivariate-linear regression model. We found a significant additive interaction between acute kidney injury and VKORC1 (-1.17, 95%CI -1.82 to -0.53, p=0.0004). This result suggests it is probable that there is an interaction between acute kidney injury and the genotype for the warfarin dose during the initial period of anticoagulation prophylaxis.