Influence of renal insufficiency on anticoagulant effects and safety of warfarin in Chinese patients: analysis from a randomized controlled trial

Abstract

This study aimed to analyze the influence of renal insufficiency on the anticoagulant effects and safety of warfarin in Chinese patients. Data on the creatinine levels of participants enrolled in a randomized controlled study were screened and divided into the non-renal insufficiency group, mild renal insufficiency group, and moderate renal insufficiency group, according to the creatinine clearance rate. The primary outcome measures were stable dose and average daily dose of warfarin. Secondary outcome measures were percentage of time in the therapeutic international normalized ratio (INR) (%TTR), and the first time to reach the therapeutic INR. Adverse events included bleeding events, thromboembolic events, and mortality. All participants with renal function test results and a baseline INR of less than 1.5 were included in the primary and secondary outcome analysis. The SPSS Statistics 21.0 software was used for statistical analysis. The randomized controlled trial was registered in Clinicaltrials.gov (NCT02211326). A total of 571 patients were included in this analysis. Multiple regression analysis showed that the renal function was correlated with stable dose, average daily dose, and the first time to reach therapeutic INR after adjusting for confounding factors. However, no correlation was noted between kidney function and %TTR. No significant differences were observed across the various safety parameters among the three groups. Renal function is an important consideration in patients using warfarin.

Influence of Renal Impairment and Genetic Subtypes on Warfarin Control in Japanese Patients

“…Previous studies have demonstrated the influence of renal impairment on the warfarin maintenance dose [16][17][18]. Moreover, the influence of reduced kidney function was associated with lower warfarin doses after accounting for clinical and genetic factors [29].…”

“…Previously, warfarin management was similar for patients with renal dysfunction and the general population [15]. However, past studies have demonstrated the influence of renal impairment on warfarin dosing [16][17][18]. Moderate and severe kidney impairments have been associated with a reduction in warfarin dose requirements.…”

Associated factors and safety of the rapidly achieving first therapeutic target of warfarin in hospitalized patients: a retrospective cohort study

“…Notably, our study found that severe RI may be marginally related to the rapidly achieving rst INR target of warfarin (P = 0.057). A multicenter prospective study found that the achieving rst therapeutic time among patients with severe RI was earlier than those without severe RI [24]. Another previous study, involving 1104 patients with nonvalvular atrial brillation (NVAF), showed that increased creatinine clearance was an independent factor for the prolonged achieving rst therapeutic INR time [20].…”

Research Methods and New Advances in Drug–Drug Interactions Mediated by Renal Transporters

“…At the same time, it also mediates the occurrence of DDIs, which, in turn, affects the efficacy of drugs. In severe cases, it can lead to adverse reactions and even endanger the lives of patients [ 46 , 47 ]. Therefore, it is necessary to study the effect of kidney disease on renal drug transporters.…”