Evaluation of the impact of body mass index on warfarin requirements in hospitalized patients

Tellor, Katie B.; Nguyen, Steffany; Bultas, Amanda C.; Armbruster, Anastasia L.; Greenwald, Nicholas A.; Yancey, Abigail M.

doi:10.1177/1753944718781295

Cited by 17 publications

(12 citation statements)

References 13 publications

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“…In a recent study reviewing warfarin dosing in patients stratified by BMI, participants with a high BMI, particularly more than 40 kg/m 2 had significantly higher warfarin requirements. [ 74 ] A higher weekly dose of warfarin may have implications for time to discharge if the drug is commenced in hospital or in maintaining time in therapeutic range. It would seem that the use of direct oral anticoagulants (DOACs) including dabigatran, apixaban, rivaroxaban and edoxaban for thromboembolism prophylaxis would address this issue.…”

Section: Management Of Af In Obese Patientsmentioning

confidence: 99%

Obesity and Atrial Fibrillation: Epidemiology, Pathophysiology and Novel Therapeutic Opportunities

Vyas

Lambiase

2019

Arrhythm Electrophysiol Rev

102

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Obesity is already a major global public health issue, implicated in a vast array of conditions affecting multiple body systems. It is now also firmly established as an independent risk factor in the incidence and progression of AF. The rapidly rising morbidity, mortality and healthcare costs associated with AF despite implementation of the three pillars of AF management – anticoagulation, rate control and rhythm control – suggest other strategies need to be considered. Compelling data has unveiled novel insights into adipose tissue biology and its effect on arrhythmogenesis while secondary prevention strategies targeting obesity as part of a comprehensive risk factor management programme have been demonstrated to be highly effective. Here, the authors review the epidemiological basis of the obesity–AF relationship, consider its underlying pathophysiology and discuss new therapeutic opportunities on the horizon.

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Section: Management Of Af In Obese Patientsmentioning

confidence: 99%

Obesity and Atrial Fibrillation: Epidemiology, Pathophysiology and Novel Therapeutic Opportunities

Vyas

Lambiase

2019

Arrhythm Electrophysiol Rev

102

View full text Add to dashboard Cite

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“…For example, Routledge et al [19] identified one of the key factors affecting on warfarin therapy is body weight. Tellor [20] showed morbidly obese patients required higher total weekly dose to maintain a therapeutic INR. Wallace et al [21] compared average warfarin dose with the different patients BMI to get the therapeutic INR in hospital, and found warfarin response dose was decreasing with the BMI increment.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the impact of body mass index on venous thromboembolism risk factors

Tajik¹,

Wang²,

Zhang³

et al. 2020

PLoS ONE

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In this paper, we investigate the interaction impacts of body mass index (BMI) on the other important risk factors for venous thromboembolism (VTE), using deep venous thrombosis (DVT) patient data from the International Warfarin Pharmacogenetics Consortium (IWPC). We apply eight machine learning techniques, including naive Bayes classifier (NB), support vector machine (SVM), elastic net regression (ENET), logistic regression (LR), lasso regression (LAR), multivariate adaptive regression splines (MARS), boosted regression tree (BRT) and random forest model (RF). The RF method is selected as the best model for classification. Out of 33 features considered in this study, we identify 12 variables as relatively important risk factors for VTE. Finally, we examine the interaction impacts of BMI on these important VTE risk factors. We conclude that the impacts of risk factors on VTE incidence are varying across different BMI groups, and the variations are different for different risk factors. Therefore the interaction impacts of BMI on the other risk factors have to be taken into account in order to better understand the incidence of VTE.

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“…The third patient who also experienced hematuria had an INR value below the therapeutic target on the second and third day with 0.91 and 1.02 INR, respectively. Data limitations of patient characteristics in this study, including BMI which is known to have a higher requirement of warfarin weekly dose to reach the therapeutic target of INR (Tellor et al, 2018), remain unknown. Even though the patient has not reached INR therapeutic target with a likely risk of thromboembolism, the patient experienced bleeding on the fifth and ninth day.…”

Section: Resultsmentioning

confidence: 99%

Bleeding Incidence in Patients Administered with Warfarin at Secondary Hospitals in Yogyakarta Province

Ningrum

Sufiyah²,

Widyastuti

et al. 2020

Indonesian J Pharm

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Warfarin is an oral anticoagulant most-commonly prescribed for prevention and treatment of thromboembolism. It is widely acknowledged that warfarin has both narrow therapeutic index and various drug-food interactions, thus carrying the risk of subtherapeutic or bleeding. Therefore, warfarin is among the priority drugs to be evaluated to improve the quality of care for warfarin use. This study aimed to analyze the indications and dosage as well as the bleeding incidence in warfarin use at secondary hospitals in Yogyakarta. This research employed the retrospective cross-sectional design among outpatients and inpatients who received warfarin for a minimum of three days. Data of patient demographics, indications and doses of warfarin, incidence of bleeding, and other drugs interacting with warfarin were collected from the medical records for two years of research. The bleeding incidence could include conjunctival bleeding, melena, hematemesis, petechiae, purpura, ecchymosis, or hematochezia as was documented in the medical records. The research involved 139 patients with a majority of male patients and age range of >60 years. The three highest indications of warfarin use were CHF (37.41%), CHF-AF (23.74%), and AF (10.79%) with an average dose of 1.83±0.54 mg/day. Despite the administration of low doses of warfarin, four patients (2.90%) experienced bleeding with hematuria as the main clinical manifestation. This study recommends adjusting to a lower warfarin dose, particularly for the elderly who receive a combination with aspirin. In addition to a lower maintenance dose, a lower therapeutic target of INR should be further verified for Indonesian patients who receive warfarin.

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Evaluation of the impact of body mass index on warfarin requirements in hospitalized patients

Abstract: Based on the results of this study, morbidly obese patients may require higher TWD to obtain and maintain a therapeutic INR.

Cited by 17 publications

References 13 publications

Obesity and Atrial Fibrillation: Epidemiology, Pathophysiology and Novel Therapeutic Opportunities

Obesity and Atrial Fibrillation: Epidemiology, Pathophysiology and Novel Therapeutic Opportunities

Evaluation of the impact of body mass index on venous thromboembolism risk factors

Bleeding Incidence in Patients Administered with Warfarin at Secondary Hospitals in Yogyakarta Province

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