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

机译：评估体重指数对住院患者华法令需求的影响

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Despite well established empiric dose adjustments for drug and disease-state interactions, the impact of body mass index (BM) on warfarin remains unclear. The objective of this study is to evaluate warfarin requirements in hospitalized patients, stratified by BMI. This retrospective review included two cohorts of patients: cohort A (patients admitted with a therapeutic international normalized ratio (INR)) and cohort B (newly initiated on warfarin during hospitalization). Exclusion criteria included: age under 18 years, pregnancy, INR (goal 2.5–3.5), and warfarin thromboprophylaxis post orthopedic surgery. The primary outcome was mean total weekly dose (TWD) of warfarin based on weight classification: underweight (BMI 2), normal/overweight (BMI 18–29.9 kg/m2), obese (BMI 30–39.9 kg/m2), and morbidly obese (BMI ? 40 kg/m2). Data were extracted from two community hospitals in reverse chronologic order during July 2015–June 2013 until both study institutions evaluated 100 patients per cohort in each BMI classification or until all patients had been evaluated within the prespecified timeframe. A total of 585 patients were included in cohort A (26 underweight, 200 normal/overweight, 200 obese, 159 morbidly obese). There was a statistically significant difference in TWD as determined by one-way analysis of variance (p post hoc test revealed a statistically significantly higher TWD in morbidly obese (41.5 mg) compared with underweight (25.6 mg, p p p p = 0.035). Of those, there was a statistically significant difference in TWD (p = 0.021) with a higher TWD in the morbidly obese (41 mg) compared with underweight patients (24.4 mg, p = 0.017). Based on the results of this study, morbidly obese patients may require higher TWD to obtain and maintain a therapeutic INR.
机译：尽管对药物和疾病状态相互作用的经验性剂量调整已得到很好的确定，但体重指数（BM）对华法林的影响仍不清楚。这项研究的目的是评估按BMI分层的住院患者的华法林需求量。这项回顾性回顾包括两组患者：A组（接受国际标准化标准化治疗（INR）的患者）和B组（住院期间刚开始使用华法林治疗的患者）。排除标准包括：18岁以下，怀孕，INR（目标2.5-3.5）和骨科手术后的华法林血栓预防。主要结果是根据体重分类的华法林平均每周总剂量（TWD）：体重过轻（BMI 2），正常/超重（BMI 18–29.9 kg / m2），肥胖（BMI 30–39.9 kg / m2）和病态肥胖（BMI = 40千克/平方米）。数据是从2015年7月至2013年6月从两家社区医院按时间倒序提取的，直到两家研究机构在每个BMI分类中评估了每个队列100名患者，或者直到在预定的时间范围内评估了所有患者。队列A中共纳入585例患者（体重不足26例，正常/超重200例，肥胖200例，病态肥胖159例）。通过单向方差分析确定的TWD具有统计学上的显着差异（p事后检验显示，病态肥胖（41.5 mg）的TWD与体重不足的25.6 mg，pppp = 0.035相比，统计学上显着更高。病态肥胖者（41 mg）与体重不足者（24.4 mg，p = 0.017）相比，TWD差异有统计学意义（p = 0.021），而TWD较高。根据这项研究的结果，病态肥胖患者可能需要更高的TWD才能获得并维持治疗用INR。

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