Impact of Antibacterials on the Quality of Anticoagulation Control in Patients Initiating Warfarin Therapy.

IF 2.8 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS American Journal of Cardiovascular Drugs Pub Date : 2024-10-29 DOI:10.1007/s40256-024-00690-0

Kyohei Sugiyama, Keita Hirai, Masato Tsutsumi, Shota Furuya, Kunihiko Itoh

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Abstract

Background: Warfarin interacts with antibacterials to prolong the prothrombin time international normalized ratio (PT-INR) and increase the risk of bleeding. Patients initiating warfarin therapy often undergo precise dosage adjustments; however, the clinical implications of these interactions with antibacterials remain unclear. This study aimed to clarify the effect of antibacterials on PT-INR during the warfarin induction phase.

Methods: This was a retrospective, observational study. Patients who were newly treated with warfarin after cardiovascular surgery were included. The primary endpoint was the comparison of the maximum PT-INR and time in therapeutic range (TTR) after warfarin initiation between the antibacterial-treated (ABx) and non-treated (non-ABx) groups.

Results: The maximum PT-INR was significantly higher in the ABx group (which included β-lactams, glycopeptides, quinolones, tetracyclines, and aminoglycosides) than in the non-ABx group (median [interquartile range] 2.37 [2.03-2.71] vs. 2.08 [1.93-2.33]; P = 0.005); however, the TTR did not differ significantly (65% [44-76] vs. 71% [43-85]; P = 0.150). The odds ratio for maximum PT-INR > 2.6 with antimicrobial therapy was 2.51 (95% confidence interval 1.21-5.21).

Discussion: Antibacterial therapy was a risk factor for a maximum PT-INR >2.6. However, there was no association with the TTR, which is a marker of good outcomes. This was due to the strict warfarin dosing regimen according to the algorithm, which immediately and appropriately adjusted for PT-INR overexpansion.

Conclusions: Antibacterials have been suggested to increase PT-INR during the induction phase of warfarin. However, with strict dose adjustments, the clinical impact on the PT-INR and TTR is likely limited.

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抗菌药物对开始接受华法林治疗的患者抗凝控制质量的影响

背景：华法林与抗菌药物相互作用会延长凝血酶原时间国际标准化比值（PT-INR）并增加出血风险。开始接受华法林治疗的患者通常需要进行精确的剂量调整；然而，这些与抗菌药相互作用的临床影响仍不清楚。本研究旨在阐明抗菌药对华法林诱导阶段 PT-INR 的影响：这是一项回顾性观察研究。研究纳入了心血管手术后新接受华法林治疗的患者。主要终点是比较抗菌药治疗组（ABx）和非抗菌药治疗组（non-ABx）在开始使用华法林后的最大 PT-INR 和治疗范围内时间（TTR）：ABx组（包括β-内酰胺类、糖肽类、喹诺酮类、四环素类和氨基糖苷类）的最大PT-INR明显高于非ABx组（中位数[四分位距]2.37 [2.03-2.71] vs. 2.08 [1.93-2.33]; P = 0.005）；然而，TTR 并无显著差异（65% [44-76] vs. 71% [43-85]; P = 0.150）。抗菌治疗导致最大 PT-INR > 2.6 的几率比为 2.51（95% 置信区间为 1.21-5.21）：讨论：抗菌治疗是导致最大 PT-INR >2.6 的一个风险因素。讨论：抗菌治疗是导致最大 PT-INR >2.6 的风险因素，但与作为良好预后标志的 TTR 无关。这要归功于根据算法制定的严格的华法林用药方案，该方案可立即对 PT-INR 过度扩张进行适当调整：结论：抗菌药物被认为会增加华法林诱导阶段的 PT-INR。结论：抗菌药物可增加华法林诱导期的 PT-INR 值，但在严格调整剂量的情况下，对 PT-INR 和 TTR 的临床影响可能有限。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Cardiovascular Drugs 医学-心血管系统

CiteScore

6.70

自引率

3.30%

发文量

审稿时长

>12 weeks

期刊介绍： Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents. Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations. The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.