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

Authors
  • Tellor, Katie B1
  • Nguyen, Steffany N2
  • Bultas, Amanda C3
  • Armbruster, Anastasia L4
  • Greenwald, Nicholas A5
  • Yancey, Abigail M4
  • 1 Department of Pharmacy Practice, St Louis College of Pharmacy, 4588 Parkview Place, St Louis, MO 63110, USA.
  • 2 Memorial Hermann, Texas Medical Center, Houston, TX, USA.
  • 3 Barnes Jewish Hospital, St Louis, MO, USA.
  • 4 Department of Pharmacy Practice, St Louis College of Pharmacy, St Louis, MO, USA.
  • 5 St Louis College of Pharmacy, St Louis, MO, USA.
Type
Published Article
Journal
Therapeutic advances in cardiovascular disease
Publication Date
Aug 01, 2018
Volume
12
Issue
8
Pages
207–216
Identifiers
DOI: 10.1177/1753944718781295
PMID: 29914293
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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 <18 kg/m2), 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 < 0.05). A Tukey post hoc test revealed a statistically significantly higher TWD in morbidly obese (41.5 mg) compared with underweight (25.6 mg, p < 0.05), normal/overweight (28.8 mg, p < 0.05) and obese patients (32.4 mg, p < 0.05). In cohort B, 379 patients were evaluated (9 underweight, 166 normal/overweight, 152 obese, 52 morbidly obese). Overall, 191 patients had a therapeutic INR on discharge (88.9% underweight, 52.4% normal/overweight, 44.1% obese, 55.8% morbidly obese, 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.

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