ObjectiveTo verify the reliability of Anticlot Assistant, a patient self-management system for warfarin therapy assisted by artificial intelligence.MethodsIt was a single-center, prospective cohort study. The eligible 34 participants were recruited consecutively between November 29, 2017 to September 27, 2018 and managed by warfarin therapy via Anticlot Assistant. The recommendations of Anticlot Assistant were examined and verified by the doctors to ensure the security. Medical records were exported from the the background management system. An univariate analysis compared the outcomes between accepted and overridden records and a logistic regression model was built to determine independent predictors of the outcomes. The research team analyzed 153 medical records, which were from 18 participants and were input by 19 doctors. There were 97 records with doctor accepting the suggestion and 56 records with doctor rejecting the suggestion .ResultsWhen the doctors accepted the recommendations, the percentage of the next-test international normalized ratio (INR) in the therapeutic range was higher (64.95% vs. 44.64%, RR=2.298, 95%CI 1.173 to 4.499, P=0.014). The logistic regression analysis revealed that accepting the recommendations was an independent predictor for the next-test INR being in the therapeutic range after controlling potentially confounding factors (OR=2.446, 95%CI 1.103 to 5.423, P=0.028).ConclusionThe algorithm of Anticlot Assistant is reasonable and reliable.
Objective To investigate the diagnosis and treatment of pulmonary thromboembolism (PTE) after thoracotomy. Methods We analyzed the clinical data of 10 patients with PTE after thoracotomy treated from January 2011 to March 2015. Among them were 8 males and 2 females, with their age ranging from 51 to 73 years old, averaging 61. Six patients had lung cancer lobectomy, and 4 had esophagus carcinoma resection. All the 10 patients suffered sudden shortness of breath, chest pain and palpitation within the first 40 hours to 128 hours after surgery, and the physical examinations revealed tachypnea, drop of blood pressure and tachycardia. The PTE diagnosis was confirmed after using echocardiography, three-dimensional imaging of CT pulmonary angiography. All the patients accepted the treatment combination of low molecular weight heparin and warfarin. Results All the patients were cured without complications like chest or wound bleeding. Follow-up checks 3 months after the surgery showed no relapses. Conclusions Thoracotomy patients are of high risks of PTE. The diagnosis should be based on imaging examinations. Treatment combination of low molecular weight heparin and warfarin has a remarkable effect in treating PTE patients after thoracotomy, which also has a low rate of bleeding complications.
Objective To investigate the vaccination rate of Coronavirus Disease 2019 (COVID-19) vaccine in patients undergoing cardiac mechanical valve replacement and to evaluate its effect on international normalized ratio (INR) value. MethodsWe investigated 132 patients who had received cardiac mechanical valve replacement and followed up in the Department of Cardiovascular Surgery, West China Hospital of Sichuan University from May to October 2021. There were 51 males and 81 females aged 26-72 (53.01±9.51) years. ResultsThe vaccination coverage rate was 53.8%. Among the 61 unvaccinated patients, concerns about heart side-effects were the main reason. The average INR of the first review after vaccination was higher than that of the last review before vaccination, with a difference of 0.40±0.72 (P<0.001). ConclusionThe vaccination rate of patients after cardiac mechanical valve replacement is low. At the same time, COVID-19 vaccine may increase INR value, and it is suggested that patients should increase the frequency of review and adjust warfarin dosage after vaccination.
Objective To investigate the role of clinical pharmacists in warfarin therapy. Methods A total of 134 patients underwent prosthetic heart valve replacement and had warfarin for life from March 2013 to October 2013 in Fujian Medical University Union Hospital. All patients were equally divided into two groups (an intervention and a non-intervention group) crosswise by sequence. There were 67 patients in each group. The anticoagulant effects of the two groups were compared. Results There was no statistical difference in the patients' demographic information between the two groups. However, the time for the patients to reach the target international normalized ratio(INR) values for the first time (7.1±3.3 dvs. 10.5±5.0 d,P=0.000) and time of INR in the therapy range (46.3%±18.8%vs.19.0%±16.2%,P=0.000) during their hospitalization, proportion of time of under anticoagulation (47.5%±19.5%vs. 71.2%±22.9%,P=0.000), proportion of time of anticoagulation overdose (5.3%±8.2%vs. 9.9%±16.7%,P=0.002) were significantly different. While there was no statistical difference in postoperative hospitalization time between the two groups (19.9±6.6 dvs. 18.1±7.0 d,P=0.137). There were 4 patients (6.0%) with minor hemorrhage and no severe complication was found in the intervention group. There were seven patients (10.4%) with mild hemorrhage, two patients with stroke, one patient with mild pulmonary embolism, and severe complication rate of 4.5% in the non-intervention group. Conclusion With clinical pharmacists involved in the whole anticoagulation therapy progress of patients after mechanical heart valve replacement, the time to achieve the therapeutic window for the first time is effectively shorten, and the time of the INR value controlled in therapeutic range is highly improved during hospitalization time. Moreover, the patients' risk of thrombosis and bleeding is eventually reduced.
Objective To explore the efficacy and safety of different Wafarin anticoagulation intensities in preventing thromboembolism in patients with paroxysmal non-valvular atrial fibrillation (PAF). Methods The patients with PAF were enrolled and divided into four groups. The patients were treated by different Wafarin anticoagulation intensities. The values of the control of international normalized ratio (INR) were 1.3-1.6 in Group 1, 1.7-2.0 in Group 2, 2.0-2.5 in Group 3, and 2.6-3.0 in Group 4. Main destination events, secondary destination events, main bleeding events, secondary bleeding events, main events (main destination events + main bleeding events), secondary events (secondary destination events + secondary bleeding events), and total events (main events + secondary events) were observed and compared in the four groups, respectively. Relevance between events of thromboembolism as well as bleeding and INR was analyzed. Results A total of 868 patients with moderate-high risk PAF were enrolled, and 826 patients (167 cases in Group 1, 220 cases in Group 2, 215 cases in Group 3, and 224 in Group 4) were included in final analysis. The follow-up results showed that the increase of INR led to a reduction in the destination events (there were significant differences between Group 1 and Group 2, 3, and 4 with Plt;0.05), but the bleeding events tended to rise. In terms of the incidence of main events, secondary events and total events, Group 1 was higher than Group 2, 3, and 4 with significant differences (Plt;0.05), except that the main event incidence of Group 1 was not significantly different from that of Group 4 (Pgt;0.05). Conclusion For Chinese patients with PAF, anticoagulation intensities of Wafarin with INR 1.7-2.5 can reduce the destination events with no rise in bleeding events. The anticoagulation intensities within this extent are safe and effective
Objective To explore clinical effect and safety of rivaroxaban in treatment of acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs. Methods The clinical data of 60 patients with acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs, collected from January 2010 to March 2017 in Hunan Provincial People’s Hospital, were retrospectively analyzed. According to the different treatment, these patients were randomly divided into a rivaroxaban group and a control group (traditional warfarin anticoagulation), with 30 patients in each group. The clinical effect and safety were compared between two groups on the 10th day, 20th day and 30th day after treatment. Results Compared with the control group, maximum short axis diameter, ratio of right and left ventricles, systolic pulmonary artery pressure, and main pulmonary artery diameter measured by CTPA and echocardiography in the rivaroxaban group were not significantly different on the 10th day, 20th day and 30th day after treatment. However, the intragroup differences were statistically significant at different timepoint (P<0.05). Levels of N-terminal-pro-brain natriuretic peptide of two groups after treatment were significantly reduced on the 10th day, 20th day and 30th day after treatment, and the values of PO2 were significantly increased on the 10th day and 20th day after treatment (P<0.05), but no significant differences were found in the values of PO2 on 20th day and 30th day after treatment. D-dimer in the two groups was obviously increased on the 10th day after treatment but significantly declined on the 20th day and 30th day after treatment (all P<0.05). These changes were predominant in the rivaroxaban group. Conclusion Rivaroxaban is effective and safe for acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs, and worthy of clinical implementation and application.
Warfarin is one of the most frequently prescribed oral anticoagulant. Many researches have shown that the genotypes have been strongly associated with warfarin maintenance doses. Especially, it has been accepted in academia that cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase complex 1 subunit (VKORC1) could affect the warfarin maintenance doses. There are also many other genotypes that were reported to be related to warfarin doses, but the results have been in controversial so far. The studies found that the dose formula which contained the genetic factors and clinical information could accurately predict the maintenance dose of warfarin, however, its usefulness is suspected due to the inconsistent results of clinical trials. Large-sample and multi-center studies are necessary to verify the specific effects of gene and non-gene factors to warfarin dose; at the same time, testing constructed models or building new models help to improve the explained percentages of individual differences.
ObjectiveTo explore the anticoagulant strategy of adjusting the dose of warfarin at different stages after mechanical valve replacement of mitral valve.MethodsClinical data of a total of 302 patients, including 76 males and 226 females, with an average age of 50.1±10.1 years, who underwent mechanical mitral valve replacement in the Chinese adult cardiac surgery database from 2013 to 2017 were retrospectively analyzed. According to the dose adjustment strategy of taking warfarin, the patients were divided into a D group (adjusting warfarin dose in days) and a W group (adjusting warfarin dose in weeks) to evaluate the anti-coagulation effect of warfarin.ResultsThe total follow-up time was 423277 d (1159.7 years). There was no significant difference in the overall anticoagulant strength, and the warfarin dose adjusted in days was better in the early postoperative period (P<0.05), especially in patients over 60 years. It was better to adjust warfarin dose in weeks in the middle and long periods (P<0.05), especially in patients ≤40 years. In terms of the stability of anticoagulation, it was better to adjust the dosage of warfarin in weeks (P<0.05). It was better to adjust the dosage of warfarin in weeks for early, middle- and long-term anticoagulant therapy after operation (P<0.05), especially in the females aged >40 and ≤50 years.ConclusionWithin the target range of international normalized ratio (1.5-2.5), the anticoagulant strategy of adjusting warfarin dose in days after mechanical valve replacement of mitral valve can achieve a better anticoagulant strength, and adjusting the dosage of warfarin in weeks is better in the middle- and long-term after operation. In general, the anticoagulant effect is more stable in the short term when warfarin dose is adjusted on a weekly basis.
ObjectiveTo investigate the factors influencing international normalized ratio (INR)>3.0 in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement. MethodsA retrospective analysis was performed on the clinical data of patients who underwent mechanical heart valve replacement surgery and received warfarin anticoagulation therapy at West China Hospital of Sichuan University from January 1, 2011 to June 30, 2022. Based on the discharge INR values, patients were divided into two groups: an INR≤3.0 group and an INR>3.0 group. The factors associated with INR>3.0 at the time of discharge were analyzed. ResultsA total of 8901 patients were enrolled, including 3409 males and 5492 females, with a median age of 49.3 (43.5, 55.6) years. The gender, body mass index (BMI), New York Heart Association (NYHA) cardiac function grading, INR, glutamic oxaloacetic transaminase, and preoperative prothrombin time (PT) were statistically different between the two groups (P<0.05). Multivariate logistic regression analysis revealed that lower BMI, preoperative PT>15 s, and mitral valve replacement were independent risk factors for INR>3.0 at discharge (P<0.05). ConclusionBMI, preoperative PT, and surgical site are factors influencing INR>3.0 at discharge in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement. Special attention should be given to patients with lower BMI, longer preoperative PT, and mitral valve replacement to avoid excessive anticoagulation therapy.
目的:探讨不同抗凝强度华法林应用于非瓣膜性心房颤动患者的可行性及安全性。方法:91例非瓣膜性心房颤动患者随机分为三组:低抗凝强度［国际标准化比率（INR）1.5～1.9］；标准抗凝强度组（INR 2.0～2.5）和阿司匹林组，观察三组血栓栓塞并发症和出血等不良反应的发生率以及C反应蛋白浓度变化。结果:标准抗凝强度组血栓发生率低于低抗凝强度组、阿司匹林组，不同强度华法林抗凝组血栓栓塞率比较差异无统计学意义；标准抗凝强度组出血发生率低于其他两个组，但三组患者出血发生率比较无统计学意义（Pgt;0.05）；治疗后低抗凝强度组、标准抗凝强度组C反应蛋白浓度明显低于治疗前（Plt;0.05），治疗后阿司匹林组C反应蛋白水平明显高于低抗凝强度组、标准抗凝强度组（Plt;0.01）。结论:华法林抗凝维持INR值在2.0～2.5时能降低非瓣膜性房颤患者血栓栓塞发生率，出血发生率低，有效性和安全性好。