Warfarin doses in the initiation phase among patients with heart valve replacement and atrial fibrillation in Hospital Pulau Pinang

The use of warfarin is essential in patients having Atrial Fibrillation (AF), Aortic Valve Replacement (AVR) and Mitral Valve Replacement (MVR). However, the use of warfarin may bring major adverse effects such as bleeding and it has dose related side effects. Due to higher incidence of bleeding...

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Main Author:	Jia, Teoh Chee
Format:	Thesis
Language:	English
Published:	2011
Subjects:	R Medicine (General) RM300-666 Drugs and their actions
Online Access:	http://eprints.usm.my/57533/1/TEOH%20CHEE%20JIA%20-%20e.pdf
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id	my-usm-ep.57533
record_format	uketd_dc
spelling	my-usm-ep.575332023-03-26T07:18:15Z Warfarin doses in the initiation phase among patients with heart valve replacement and atrial fibrillation in Hospital Pulau Pinang 2011 Jia, Teoh Chee R Medicine (General) RM300-666 Drugs and their actions The use of warfarin is essential in patients having Atrial Fibrillation (AF), Aortic Valve Replacement (AVR) and Mitral Valve Replacement (MVR). However, the use of warfarin may bring major adverse effects such as bleeding and it has dose related side effects. Due to higher incidence of bleeding in initial phase of warfarin therapy and reported fluctuation of dose in initial phase of warfarin therapy after heart valve surgery, this study was conducted to evaluate the changes in warfarin doses among patients after heart valve surgery and atrial fibrillation. All patients having atrial fibrillation, aortic valve replacement and mitral valve replacement who were initiated warfarin therapy in year 2008 till 2010 in Hospital Pulau Pinang was selected as samples. A total of 137 patients were included for this study. Data collected included patient’s age. race, gender, warfarin initiation date, warfarin indication, warfarin dose and INR value for 1st till 12th weeks of warfarin initiation. Statistical analysis was performed using repeated measures ANOVA and repeated measures ANCOVA. Heart valve replacement patients (AVR or MVR) showed increasing trend in warfarin doses during the initial phase of warfarin therapy. This trend was not observed in Al-' patients. The dose of warfarin warfarin initiation for AVR and MVR group (p-value <0.001) but there was no significant difference in AF group. The dose of warfarin was significantly different among AVR and AF patients for first 5 weeks of warfarin initiation. Indications (p-value =0.036) and race (p-value =0.016) were found to be significantly affecting warfarin doses in the initial phase of warfarin therapy but not gender (p-value =0.122) and age (p-value =0.280). Overall, the mean dose of warfarin required was lower compared to western countries. Monitoring should be frequent for patients with heart valve replacement during the initial 3 months period of warfarin therapy. 2011 Thesis http://eprints.usm.my/57533/ http://eprints.usm.my/57533/1/TEOH%20CHEE%20JIA%20-%20e.pdf application/pdf en public other Universiti Sains Malaysia Pusat Pengajian Sains Perubatan
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	R Medicine (General) RM300-666 Drugs and their actions
spellingShingle	R Medicine (General) RM300-666 Drugs and their actions Jia, Teoh Chee Warfarin doses in the initiation phase among patients with heart valve replacement and atrial fibrillation in Hospital Pulau Pinang
description	The use of warfarin is essential in patients having Atrial Fibrillation (AF), Aortic Valve Replacement (AVR) and Mitral Valve Replacement (MVR). However, the use of warfarin may bring major adverse effects such as bleeding and it has dose related side effects. Due to higher incidence of bleeding in initial phase of warfarin therapy and reported fluctuation of dose in initial phase of warfarin therapy after heart valve surgery, this study was conducted to evaluate the changes in warfarin doses among patients after heart valve surgery and atrial fibrillation. All patients having atrial fibrillation, aortic valve replacement and mitral valve replacement who were initiated warfarin therapy in year 2008 till 2010 in Hospital Pulau Pinang was selected as samples. A total of 137 patients were included for this study. Data collected included patient’s age. race, gender, warfarin initiation date, warfarin indication, warfarin dose and INR value for 1st till 12th weeks of warfarin initiation. Statistical analysis was performed using repeated measures ANOVA and repeated measures ANCOVA. Heart valve replacement patients (AVR or MVR) showed increasing trend in warfarin doses during the initial phase of warfarin therapy. This trend was not observed in Al-' patients. The dose of warfarin warfarin initiation for AVR and MVR group (p-value <0.001) but there was no significant difference in AF group. The dose of warfarin was significantly different among AVR and AF patients for first 5 weeks of warfarin initiation. Indications (p-value =0.036) and race (p-value =0.016) were found to be significantly affecting warfarin doses in the initial phase of warfarin therapy but not gender (p-value =0.122) and age (p-value =0.280). Overall, the mean dose of warfarin required was lower compared to western countries. Monitoring should be frequent for patients with heart valve replacement during the initial 3 months period of warfarin therapy.
format	Thesis
qualification_level	other
author	Jia, Teoh Chee
author_facet	Jia, Teoh Chee
author_sort	Jia, Teoh Chee
title	Warfarin doses in the initiation phase among patients with heart valve replacement and atrial fibrillation in Hospital Pulau Pinang
title_short	Warfarin doses in the initiation phase among patients with heart valve replacement and atrial fibrillation in Hospital Pulau Pinang
title_full	Warfarin doses in the initiation phase among patients with heart valve replacement and atrial fibrillation in Hospital Pulau Pinang
title_fullStr	Warfarin doses in the initiation phase among patients with heart valve replacement and atrial fibrillation in Hospital Pulau Pinang
title_full_unstemmed	Warfarin doses in the initiation phase among patients with heart valve replacement and atrial fibrillation in Hospital Pulau Pinang
title_sort	warfarin doses in the initiation phase among patients with heart valve replacement and atrial fibrillation in hospital pulau pinang
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan
publishDate	2011
url	http://eprints.usm.my/57533/1/TEOH%20CHEE%20JIA%20-%20e.pdf
_version_	1776101201171972096

Warfarin doses in the initiation phase among patients with heart valve replacement and atrial fibrillation in Hospital Pulau Pinang

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