药物相关基因型指导的华法林初始给药剂量对心脏瓣膜置换术后抗凝疗效的影响  

Effect of genotype-guided initial dose of warfarin on anticoagulation after heart valve replacement

作　　者：李晓烨 许青 李晓宇 吕迁洲 LI Xiaoye;XU Qing;LI Xiaoyu;LYU Qianzhou(Department of Pharmacy,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院药剂科,上海200032

出　　处：《上海医药》2022年第5期1-3,31,共4页Shanghai Medical & Pharmaceutical Journal

基　　金：上海市临床重点专科建设项目(shslczdzk06504)。

摘　　要：目的:探讨使用药物相关基因型指导的华法林初始给药剂量对心脏瓣膜置换术后抗凝疗效的影响。方法:纳入心脏瓣膜置换术后服用华法林抗凝治疗的患者,根据药物相关基因型计算华法林初始给药剂量,记录随访3个月内患者国际标准化比值(international normalized ratio,INR)达标的次数、INR在治疗范围内的时间(time in therapeutic range,TTR)和血栓形成、出血事件。结果:共纳入45例心脏瓣膜置换术后服用华法林治疗的患者,对所有患者均完成了3个月的随访。华法林初始给药剂量范围为1.875~3.0 mg/d,平均中位给药剂量为2.5 mg/d。随访期中共监测患者INR 869次,其中达标的有714次,平均TTR为82.2%(其中第1周内TTR最低,为62.3%)。结论:使用药物相关基因型指导的华法林初始给药剂量治疗能有效减少心脏瓣膜置换术后抗凝治疗患者的血栓形成和出血事件。Objective:To investigate the clinical effect of genotype-guided initial dose of warfarin on anticoagulation after heart valve replacement.Methods:Patients who underwent valve replacement operation and anticoagulated with warfarin were included.The initial dose of warfarin was calculated by formula,and time in therapeutic range(TTR),and thrombosis and bleeding events were followed up within 3 months.Results:A total of 45 patients taking warfarin after valve replacement were finally enrolled and completed 3-month follow-ups.The initial dose range was 1.875-3.0 mg/d,and the average median dose was 2.5 mg/d.During the follow-up period,869 international normalized ratios were monitored,of which 714 reached the target.The mean TTR was 82.2%,and the lowest TTR was 62.3%in the first week after administration.Conclusion:The genotype-guided initial dose mode of warfarin after valve replacement can reduce thrombosis and bleeding events.

关 键 词：基因型指导的初始给药剂量 华法林 心脏瓣膜置换术 抗凝疗效 

分 类 号：R973.2[医药卫生—药品] R654.2[医药卫生—药学]