جستجوی مقالات مرتبط با کلیدواژه « وارفارین » در نشریات گروه « پزشکی »

Since 1950, warfarin has been widely used as an anticoagulant medication for the prevention and treatment of thromboembolism. Various factors such as age, weight, diet, and genetic factors such as CYP2C9 and VKORC1 genes are involved in determining the dose of warfarin. This study was conducted to evaluate common polymorphisms in patients treated with warfarin.

The present cross-sectional study was conducted in the laboratory of Shahid Dastghib Hospital in Shiraz, Iran, in 2019. A total of 99 patients were selected for this study. Patients were receiving warfarin for various reasons, including heart problems. CYP2C9 and VKORC1 gene polymorphisms were investigated by a multiplex PCR method.

The haplotype frequencies of CYP2C9 alleles with *1*1, *1*3, *2*3, and *3*3 combinations were 1, 9.1, 19.2, and 70.2 percent, respectively. Among VKORC1 -1639G> A gene, allele GA, by 52.5%, was most frequent, followed by GG and AA with 34.3%, and 13.1% respectively.

The results showed a significant effect of CYP2C9 and VKORC1 gene polymorphisms on the required starting dose of warfarin to maintain INR in the range of 2-3. The CYPC2CP * 3*3* and VKORC1 -1639 G>A alleles were the most common polymorphisms in the studied population. The combination of age, weight, and haplotype genotypes of CYP2C9 and VKORC1 was the best predictive value. We can calculate the weekly dose of warfarin with the regression equation and help determine the starting dose of this drug for people with similar conditions.

The similar efficacy of rivaroxaban and warfarin in thromboembolic events was recognized in clinical trials. But there are a few studies about the comparison of these medications in real world. This study was designed with the aim of comparing the efficacy and safety of the rivaroxaban and warfarin.

All patients who received rivaroxaban or warfarin during April 2019 and October 2020 were recruited in the study. The major bleeding and thromboembolic events were considered as primary outcomes. Secondary outcomes were all cause mortality and minor bleeding. All of patients were followed for six months after recruitment and the end of study.

Of 242 patients recruited during the 18 months, 116 patients received rivaroxaban and 126 received warfarin. There were no significant differences between warfarin and rivaroxaban regarding major bleeding (p=0.24) and thromboembolic events (p=0.38). The minor bleeding was significantly higher in warfarin group. (29.36% versus 12.93%, p=0.002). The all-cause mortality rate was similar between two groups (p=0.67). More than 12% of patients were discontinued rivaroxaban, due to high cost. In warfarin group, 14.28% patients did not have compliance due to laboratory fluctuations and inappropriate access to medication.

In the present study, warfarin and rivaroxaban had similar efficacy and safety. In addition, suitable compliance was observed in both groups.

Warfarin is the most commonly prescribed anticoagulant drug for treating thromboembolic events. There is a variation in dose requirements for each individual due to nongenetic factors and gene polymorphisms. In this study, we performed Tetra-ARMS PCR molecular technique in order to investigate the association between 5 gene polymorphisms and patient characteristics with warfarin dose requirements in all Iranian ethnic groups.  

This study was done on 68 Iranian patients on warfarin treatment who attended the cardiovascular centers in Tehran Province for regular INR monitoring. Genotyping of VKORC1 (rs9923231 and rs2884737), CYP4F2, and CYP2C9*3 were performed using Tetra-Arms-PCR and conventional PCR was done for the detection of CYP2C9*2 (rs1799853) SNP. Multiple regression model was performed for statistical analyses and P<0.05 was considered as the significance level.

Of 5 SNPs, VKORC1 rs9923231, CYP2C9*2, and CYP2C9*3 variants alleles had a significantly lower mean warfarin daily dose compared with the wild-type genotypes, whereas no significant association was seen between VKORC1 rs288473710, CYP4F2, and warfarin maintenance doses. Furthermore, despite a significant association between patients’ age and warfarin dose (p=0.021), it was not statistically significant for other demographic characteristics.

It can be concluded that VKORC1 rs9923231, CYP2C9*2, and CYP2C9*3 gene polymorphisms and patients’ age had a significant effect on warfarin dose. The new warfarin-dosing algorithm was developed based on VKORC1 rs9923231, CYP2C9*2, and CYP2C9*3 genotypes for predicting the required dose of warfarin.

Anticoagulation therapy is one of the most important strategies for preventing clot formation and subsequent stroke, with warfarin representing the most widely used oral anticoagulant. However, predicting the outcomes of warfarin administration poses a major challenge for physicians because of the narrow boundary between the therapeutic and toxic levels of warfarin. Clinical decision support systems (CDSSs) can be used as a tool to improve both adherence to clinical guidelines and transfer of evidence-based knowledge to daily clinical practice for dose adjustment, thereby helping reduce medical errors. The aim of this study was to develop a prototype CDSS for predicting warfarin doses according to computerized clinical guidelines.

This applied developmental study involving a qualitative design was conducted in two major steps.First, computer-interpretable guidelines were extracted from existing clinical guidelines as a workflow diagram for warfarin therapy and were subsequently evaluated by an expert panel. Second, a prototype CDSS was designed with PHP programming language and SQL database, and Nielson’s heuristic evaluation checklist was used for usability testing.

In the first step, the findings were presented in two main workflows and two sub-workflows. In the second step, a prototype CDSS was designed. The overall usability of the prototype was found to be at a "relatively acceptable" level, with a rating percentage of 92.09.

The usability evaluation results suggest that CDSSs similar to the one presented herein could serve as valuable clinical decision support tools for estimating warfarin dosage. These promising results call for further research aimed at exploring the feasibility of implementing such systems in clinical settings.

Exercise can minimize the risk of myocardial infarction (MI) by regulating cellular signaling in the heart and arteries. The aim of this study is to evaluate the effect of warfarin consumption with continuous and interval training on the expression of cardiac osteocalcin gene, vitamin MK-4 and serum calcium in myocardial infarction mice.

In this experimental study, 42 male Sprago-Dovali rats (180-120g) were randomly divided into 7 groups: healthy control, myocardial infarction or ischemia (ISC), ISC+interval training, ISC+continuous exercise, ISC+warfarin, ISC+interval training+warfarin and ISC+continuous exercise+warfarin. Induction was induced by subcutaneous isoproterenol. The duration of training was eight weeks, five sessions per week and the dose of warfarin was 0.5 mg/kg per day. Gene values, changes in vitamin K2 and calcium were analyzed by Real time-PCR, ELISA, photometric and data analysis using independent t-test, one-way variance and two-factor variance (P<0.05).

Disease induction increased the expression of osteocalcin (p=0.003), vitamin K2 (p=0.027) and calcium (p=0.001) genes compared to healthy controls. In the study of osteocalcin gene expression, ischemia+warfarin group with ischemia+EIT (p=0.014) and ischemia+ECT (p=0.007) and in the study of calcium levels of ischemia group with ischemia+EIT (p=0.014), Ischemia+ECT (p=0.001) and ischemia+warfarin+ECT (P=0.013) were significantly different. Also, the interaction between exercise and drug was not confirmed on any of the variables.

It seems that interval and continuous exercise be effective in reducing vascular degradation and calcification after MI by reducing the cardiac osteocalcin and serum calcium and minimizing the side effects of some drugs such as warfarin.

Heart-kidney disorders affect on each other. Exercise training can control heart and kidney cell damages. The aim of this study is to determine the effect of exercise training and warfarin administration on cardiac matrix Gla protein (MGP) and indices of renal injury in rats of myocardial infarction model.

In this experimental study, 42 male Sprague-Dawley rats (180-220 grams) were randomly divided into 7 groups of healthy control, myocardial infarction or ischemia (ISC), ISC+interval training, ISC+ continuous training, ISC+warfarin, ISC+interval training+warfarin, and ISC+continuous training+warfarin. The duration of interval and continuous training was eight weeks, five sessions per week. Induction of myocardial infarction was performed with subcutaneous injection of isoproterenol. Cardiac MGP was measured by western blotting, creatinine and blood urea nitrogen (BUN) by photometric method, and cystatin C by Turbidimetry. Glomerular filtration rate (GFR) was calculated according to cystatin C consideration. Independent t-test and two- factor analysis of variance were used to analyze the data.

Myocardial infraction decreased MGP protein (p=0.001), increased creatinine (p=0.001), BUN (p=0.002), and cystatin C (p=0.001), and decreased GFR (p=0.001) compared to the control group. The main effect of exercise type on all variables, the main effect of warfarin on MGP and BUN, and also interaction of warfarin and exercise type on MGP were significant.

Exercise training had a better effect on cardiac MGP and control of renal injury markers compared to warfarin. Therefore, in heart and kidney diseases with warfarin therapy, exercise training should be carefully planned.

Upper limbs deep vein thrombosis is a rare event in patients, although increasing incidence is seen due to higher cancer diagnosis rate and the use of various vascular catheters. A 58-year-old man with a history of anemia was scheduled for radical prostatectomy due to prostate adenocarcinoma. The patient underwent surgery under general anesthesia. After surgery, he was transferred to the intensive care unit. At the beginning of admission, right limb edema in the distal part of the right limb (hands and wrists) was observed that was accompanied by cyanosis and pain. The patient was diagnosed with deep vein thrombosis and was treated with anticoagulant drugs. He was discharged after 4 days in a good general condition and uneventfully. This report shows that patients with venous catheters, especially patients who are candidates for surgery, are at high risk of deep vein thrombosis and need careful monitoring after surgery.

The present review study was conducted with the aim of exploring what nurses should know about interactions of diet containing vitamin K with warfarin. Background. Warfarin is one of the most widely used oral anticoagulants. Dietary interactions, mainly due to vitamin K, are a common concern when consuming warfarin. In the meantime, the nurse, as the first person in the care chain and the main person in charge of patient education, can play an important role in reducing these interactions, which is a challenge for patients.

The present review study was conducted through searching out library as well as databases such as PubMed, Cochrane Library, Web of Science, Scopus, Up-to-date, OVID, CINAHL, Magiran and SID using Persian keywords of warfarin, dietary interactions, vitamin k diet, patient and nurse education and their English equivalents in the period 1999 to 2021. Out of a total of 30 articles found, 8 articles were reviewed after screening the articles.

The findings of this study showed that the amount of vitamin K intake in the diet should be kept constant. This is 90 to 120 micrograms per day. Patients should be properly and continuously educated about vitamin K in various foods and supplements. In the meantime, the role of the nurse as one of the pillars of patient education is very important and fundamental.

Due to the role of the nurse in educating these patients, it is recommended that education about dietary interactions be used using authoritative sources. It is possible with methods such as preparing a clinical guide, making a video and designing an application, and including tables of vitamin K levels in foods.

The main goal of the present study was to investigate the impact of preinjury intake of direct oral anticoagulants (DOACs), warfarin, and antiplatelet on clinical and radiological neuro-deterioration of patients with moderate to severe traumatic brain injury (TBI).

We investigated 224 consecutive patients more than 50 years old with moderate and severe TBI admitted to the Taleghani hospital, Kermanshah, Iran, between Jul 2014 and Jul 2019, retrospectively. Demographic, clinical, and laboratory data were retrospectively reviewed using the electronic medical records of all patients. Patients were categorized into four groups: nonuser patients, patients on platelet inhibitors, patients on warfarin and patients taking any DOACs. Clinical outcome was evaluated with the Glasgow Outcome Scale.

95 patients (42.4%) received no anti thrombotic drugs before the trauma. However, 69 patients (30.8%) were receiving platelet inhibitors, 42 subjects (18.8%) were on the warfarin, and 18 cases (8.0%) were on the DOACs before their trauma. There were 41 cases (18.3%) with in-hospital mortality. Our results showed that, 108 patients (48.2%) had a favorable outcome and 116 ones (51.8%) had an unfavorable outcome. Patients on Warfarin and those were receiving DOACs were associated with higher mortality as well as a more unfavorable clinical outcome (p<0.005).

Preinjury use of DOACs and warfarin is associated with higher mortality and worse clinical outcome. However, preinjury antiplatelet therapy did not contribute to in-hospital mortality and poor clinical outcomes.

Arterial and venous thromboembolism is one of the most common causes of death worldwide. For almost seventy years, heparin, low molecular weight heparin, and vitamin K antagonists have been widely used in the prevention and treatment of thromboembolic disorders. However, many of the limitations of these traditional anticoagulants have led to the search for and attempts to introduce better drug therapies over the past 15 years, and a new group of oral anticoagulants specifically affecting factor X and thrombin have already been introduced and are available. This review study explains the evolution of anticoagulants with a focus on oral anticoagulants and the results of important clinical trials.

Warfarin sodium as an anticoagulant, is widely used for the prevention and treatment of venous and arterial thrombosis. As a vitamin K antagonist, warfarin effectively decreases the hepatic production of clotting factors II, VII, IX, and X, along with proteins C and S. While anticoagulants such as warfarin have well-established indications, they are also associated with few side effects such as haemorrhage. Many patients receiving vitamin K antagonists have an International Normalized Ratio (INR) higher than the target of 2.0 to 3.0 for over 50% of the time, which is followed with increasing risk of bleeding. In this situation the clinical need for emergency reversal of anticoagulation is necessary. There are a number of potential treatment options for anticoagulant reversal, including administration of vitamin K (oral or intravenous), human plasma products [for example, Fresh Frozen Plasma (FFP)], prothrombin complex concentrates (PCCs); concentrates that contain coagu-lation factors II, VII, IX and X), or single coagulation factors such as activated re-combinant factor VII (rFVIIa). The aim of this paper was to conduct a review of the medical literature and summarize the advantages and risks of the available treatment options for reversing warfarin anticoagulation in patients receiving warfarin. Keywords: Warfarin, Warfarin reversal, Vitamin K, FFP, PCC, rFVIIa

Administration of warfarin, the most common oral anticoagulant, is usually accompanied with limitations. Anticoagulant effect of warfarin has wide inter-patients variations due to pharmacodynamics, pharmacokinetics and especially pharmacogenetics factors. Polymorphisms of VKORC1 gene is one of the genetic factors influencing adjustment of warfarin dosage. In order to better determine the appropriate dosage of the drug, this study was conducted to find out the allele and genotype frequencies of VKORC1 gene in population of Birjand city.

One hundred-fifteen patients who referred to Imam Reza and Vali-asr hospitals of Birjand city for PT and INR tests, were selected for this experimental study. After genomic DNA extraction, all amplified PCR products of VKORC1 were sequenced to determine the genotypes. Statistical analysis was performed using SPSS software.

The average age of patients was 57.7 ± 12.9, 55 were women and 60 were men. Normal, heterozygous and homozygous mutant genotypes of -1639 G>A variant, had a frequency of 40.3%, 30.5%, 17.5%  in men; and 50%, 36.7%, 5% in women, respectively. Regarding 1173C>T variant, normal, heterozygous and homozygous mutant genotypes had a frequency of 38.9%, 38.9%, 22.2% in men; and 52.6%, 40.4%, 7% in women, respectively. Two new mutations as g.3660G> A and g.3565G> T with the frequency of 2.7% and 0.9% in -1639 G>A promoter region of VKORC1 gene were observed.  Finally, -1639G and 1173C alleles had a high frequency (68.1% and 62.6%, respectively) in people of Birjand city.

Our results indicate that there are significant differences in the frequency of VKORC1 genetic variants in people of Birjand city compared to other parts of Iran. The ethnic differences can affect sensitivity to warfarin. Therefore, knowing the genotype of the patients before starting warfarin therapy will help to have a precise and efficient therapy.

Warfarin is anticoagulant drug and prevents thromboembolism in cases such as pulmonary embolism and blood clot in a leg vein which under high risk of thrombosis. The therapeutic window of warfarin is very narrow. Therefore, it is important to monitoring the level of warfarin in blood patient. Electrochemical sensors are powerful tools in the field of diseases diagnosis and medical care, due to advantages such as high selectivity, high sensitivity and low. The aim of this study was fabrication of an electrochemical sensor base on modification of carbon electrode using graphene nanoparticle for quantification of warfarin in plasma.
In this study, plasma sample of 8 patients who had consumed warfarin were analyzed. After precipitation of plasma proteins by acetonitrile, the sample was centrifuged and the supernatant was transferred to a test tube. The resulting solution was evaporated by stream of nitrogen gas to complete drying. The dry residue was diluted by distilled water and transferred into the voltammetric cell for evaluation of warfarin oxidation by sensor.
The results show that fabricated nano sensor strongly catalyzes the oxidation current of warfarin. Furthermore there are linear relationship (least squares method) between oxidation current of warfarin and its concentration in plasma.
The sensor as a simple, low-cost and accurate procedure is able to measure warfarin in patient's plasma.

Most of the current regimens in the treatment of multiple myeloma include thalidomide. Thalidomide is a modulator of the immune system and according to several studies, its main complication is thromboembolism. The aim of this study is to compare the thromboemboli prophylactic effect of aspirin and low dose warfarin in standard risk multiple myeloma patients that treated with regimens containing thalidomide.
In this double- blind clinical trial study, sixty-six patients with multiple myeloma under treatment with thalidomide-containing regimens with standard risk for thromboembolism who were admitted to Khansari hospital, entered the study according to inclusion and exclusion criteria. The incidence of thromboembolism in these patients was evaluated.
Five patients in the warfarin group and 2 patients in the aspirin group had thromboemboli. Chi square analyses showed no significant difference between groups (p=0.635).
The results showed that both drugs are effective in preventing thromboembolism and can be used as a prophylactic treatment.

Warfarin and other anticoagulant medications like Coumadin are widely prescribed by physicians to prevent ischemic events. A variety of factors such as sex, age and weight can affect warfarin dosage requirements. A clinical effect of warfarin depends on highly polymorphic drug-metabolizing (CYP2C9) enzymes. The objective of this study was to investigate the impact of CYP2C9*2, CYP2C9*3 polymorphisms on the variability of warfarin dosage requirements in Iranian population that were under warfarin therapy for different reasons. The study included 100 patients with the mean age of 61.3 years. The restriction fragment length polymorphism method was used to identify polymorphisms of CYP2C9 (*1, *2, *3) in Iranian patients with ischemic heart disease in Peyvand Laboratory. Two-thirds (68.42%) of the patients had the wild-type (WT) CYP2C9*1*1 genotype 10.53%, 18.95%, and 2.1% of the patients had CYP2C9 *1*2, *1*3, and *2*3 genotype, respectively. WT CYP2C9*1*1 genotype was associated with a higher daily warfarin dosage (4.58 ± 1.57 mg/day p= 0.02) as compared to other CYP2C9 genotypes. The Iranian study sample is characterized by high frequency *1*1 genotypes that determine a higher warfarin-loading dose. Analysis of CYP2C9 gene variants allows the prediction of warfarin dosage. These results can be used to individualize treatment with warfarin in Iranian patients.

Warfarin is one of the most prescribed medications in the United States for prevention both stroke and venous thromboembolism. There are numerous demographic and medical factors that can potentially complicate successful warfarin management. Patient adherence to warfarin regimens is largest determining factor of anticoagulation therapeutic effectiveness. This study aimed to determine the Relationship of demographic factors with medication adherence among Patients attending in Warfarin Clinics in Tehran was designed and conducted. This cross-sectional descriptive study was conducted on 400 eligible patients. Subjects were selected based on target. Demographic questionnaire, Modified Morisky medication adherence questionnaire, INR test and visit to the clinic were used for data collection. Of 400 patients studied, 61% were woman with mean age (± standard deviation) 52.97 ± 13.32, 57.8% had adherence with Modified Morisky medication adherence questionnaire, 73.5% had INR in therapeutic range, 38% had regular visit and 27.8% of participants had adherence with per three instruments. Adherence was related education (p=0.000), life status (p=0.041), employment status (p=0.000), home area (p=0.012) and income (p=0.002). Adherence is a behavioral multifactorial process and the role education, employment status, socioeconomic status and life status of patients in that is important. Therefore, to improve adherence, nurses should consider this factors in educational programs for these patients.

Cardioembolic stroke account for one-fifth of ischemic stroke and atrial fibrillation is the most common underlying cause. Taking an oral anticoagulation (Warfarin) is an effective way of preventing ischemic stroke but bleeding complication is common. This study was carried out to evaluate the validation of HASBLED score in prediction of hemorrhagic complications in patients with brain ischemia and atrial fibrillation under warfarin therapy. In this cohort study 112 patients with non-valvular atrial fibrillation in term of major and minor bleeding complications were followed to the predictive value of HASBLED criteria for one year. Major bleeding complications defined as intracranial bleeding, bleeding leading to hospitalization, drop of hemoglubin of more than 2gr/dl or requiring transfusion. HASBLED criteria were defined as hypertension, abnormality in liver and renal function tests, history of stroke, history of bleeding, large fluctuations in coagulation tests results, age more than 65 years and an Anti-platelet and non steroidal anti-inflammatory drugs and alcohol use one point is awarded to each of the aboves. During one year follow up, 10 (9.1%) of patients had major bleeding and 28 (25%) patients had minor bleeding. The risk of major bleeding was significantly related with a history of minor bleeding and HASBLED scores (P<0.05). The risk of minor bleeding was significantly related with warfarin toxicity and high INR (P<0.05). HASBLED score>3 was associated with the likelihood of major bleeding in future. Patients with HASBLED score>3 should be causious in initial stage of taking oral anticoagulant.

Warfarin is the most common oral anticoagulant. This drug is used for the prevention and treatment of thromboembolic patients. It is difficult for physician to predict the results of warfarin prescriptions because there is narrow boundary between therapeutic range and complications of warfarin. Therefore drug dose adjustment is normally performed by an expert physician. Decision support systems that use extracted knowledge from experts in the field of drug dose adjustment would be useful in reducing medical errors, especially in the clinics with limited access to experts. The aim of this study was to propose a method for boosting the maintenance dose of warfarin for a maximum period of three days to eliminate disruptions in International Normalized Ratio (INR). In a retrospective study, from December 2013 to February 2014 in Shahid Rajaee Heart Center, Tehran, Iran, 84 patients with International Normalized Ratio below (INR) the therapeutic range was selected who was undergone a boosting dose during three days. Patients with unstable maintenance dose were excluded from the study. In this study, data from 75 patients receiving warfarin therapy were used for developing and evaluation of the proposed model. The INR target range for 37 patients out of remaining 75 cases was between 2.5 and 3.5, while for 38 patients the intended INR range was between 2 and 3. A separate fuzzy model was designed for each of the above-mentioned therapeutic ranges. The recommended dose for 37 patients having INR therapeutic range of 2.5 to 3.5 has mean absolute error and root mean squared error of 1.89 and 2.78 respectively for three days. These error rates are 1.97 and 2.88 respectively for 38 patients who are in therapeutic range 2 to 3. The results are promising and encourage one to consider this system for more study with the aim of possible use as a decision support system in the future.

All women with prosthetic heart valve should undergo long-term treatment with anticoagulants drugs. Anticoagulants suitable for use in the treatment of pregnant women with prosthetic heart valves has met with controversy. Due to limited information on the strategies used in the treatment of pregnant women with prosthetic heart valve، this study was performed with aim to evaluate the advantages and disadvantages of the use of anticoagulants in pregnant women with prosthetic valve to achieve key points for medical use.

To access the performed studies about anticoagulant therapy in pregnant women with prosthetic valve، databases of PUBMED، MEDLINE، SCOPUS و EMBASE و DARE and also، related keywords were used. Last guidelines related to the coagulant therapy after surgery of prosthetic heart valve were studied.

best coagulation regimen in pregnant women with mechanical valve is using warfarin with dose <5 mg.

The aim of this study is to describe a case of hemomediastinum in a patient being treated with warfarin for pulmonary thromboembolism; in order to facilitate diagnosis and clinical management of patients suffering from this rare but life-threatening complication.An 80-year-old patient was admitted to Intensive Care Unit of Dr. Masih Daneshvari hospital, Shahid Beheshti Medical University due to pleuritic chest pain, dyspnea and dysphagia. The Patient's laboratory results showed anemia and an INR >8 and which was corrected by infusion of fresh frozen plasma. The aspiration of evident pleural fluid on chest radiograph, showed hemothorax. Mediastinal widening was assessed by chest CT-scan which denoted on a mediastinal hematoma. There was no other site of bleeding. Symptoms subsided with supportive care and correction of coagulopathy.Non-traumatic mediastinal hemorrhage is a rare and potentially life-threatening complication of anticoagulant therapy which must be taken into consideration even in the absence of symptoms of overt bleeding.