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Increased sensitivity to warfarin after heart valve replacement.

Mesbah Rahman¹, Taha M BinEsmael, Nicola Payne

¹Department of Cardiothoracic Surgery, University Hospital Wales, Cardiff, UK. mesbah@hotmail.com

The Annals of Pharmacotherapy

|March 2, 2006

Summary

Patients with prosthetic heart valves need lower warfarin doses initially due to increased sensitivity. Warfarin sensitivity decreases over time, requiring dose adjustments for effective anticoagulation.

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Area of Science:

Cardiology
Pharmacology
Surgical Science

Background:

Warfarin dosage for prosthetic heart valves varies significantly between immediate postoperative and long-term periods.
This variability can lead to International Normalized Ratio (INR) instability.

Purpose of the Study:

To prospectively evaluate warfarin sensitivity in patients undergoing heart valve replacement.
To quantify changes in warfarin dosage requirements and sensitivity over time.

Main Methods:

Prospective collection of clinical and laboratory data from 111 patients receiving warfarin post-heart valve replacement.
Data gathered during hospitalization (induction) and 1-3 months post-surgery (follow-up).

Main Results:

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Mean INR was similar between induction and follow-up periods (2.6 vs 2.81).

Mean warfarin dose increased by 43% in the follow-up period (3.55 mg vs 5.09 mg).

Warfarin dose index significantly decreased, indicating reduced sensitivity over time (1.16 to 0.65).

Conclusions:

Patients exhibit heightened warfarin sensitivity immediately after heart valve replacement.
Lower initial warfarin doses are recommended during the induction phase.
Increased warfarin dosage is typically required during early follow-up to maintain therapeutic anticoagulation.