Changes in Warfarin Sensitivity During Decompensated Heart Failure and Chronic Obstructive Pulmonary Disease

Area of Science:

• Cardiology
• Pulmonology
• Pharmacology

Background:

• Warfarin therapy is common for patients with cardiovascular and pulmonary conditions.
• Elevated international normalized ratio (INR) has been observed in heart failure (HF) patients on warfarin.
• Understanding warfarin sensitivity during disease exacerbations is crucial for safe anticoagulation management.

Purpose of the Study:

• To compare warfarin sensitivity in patients hospitalized for heart failure (HF) exacerbation versus chronic obstructive pulmonary disease (COPD) exacerbation.
• To compare warfarin sensitivity during acute exacerbations with periods of disease stability.
• To assess warfarin sensitivity in patients admitted for reasons unrelated to HF or COPD (controls).

Main Methods:

• A case-controlled observational study was conducted.
• Included patients admitted for HF exacerbation (n=37), COPD exacerbation (n=26), and controls (n=60).
• Warfarin sensitivity, defined as INR per daily warfarin dose, was measured at admission and compared to stable periods and between groups.

Main Results:

• Warfarin sensitivity increased significantly during exacerbations: 94% for HF (P < 0.0001) and 59% for COPD (P = 0.003).
• HF patients exhibited higher warfarin sensitivity at admission (1.62) compared to controls (0.91, P < 0.0001) and COPD patients (1.03, P = 0.04).
• HF patients required more vitamin K intervention (14%) than controls (0%, P = 0.007).

Conclusions:

• Both HF and COPD exacerbations increase warfarin sensitivity.
• HF exacerbation demonstrates the most substantial increase in warfarin sensitivity.
• These findings have significant clinical implications for managing warfarin therapy in patients with HF and COPD exacerbations.