影响中国汉族≥75岁老年口服华法林病人IWPC预测模型准确性的相关因素

目的 探讨影响≥75岁老年病人国际华法林药物基因组协会(IWPC)预测模型准确性的相关因素,为≥75岁病人更合理地应用华法林提供参考.方法 收集≥75岁口服华法林抗凝治疗的老年病人的临床资料,根据预测剂量与实际剂量间的差异率分为差异轻微组、差异一般组和差异显著组,比较各组性别、年龄、BMI、血压、心率、合并疾病及合并用...

Relevant factors influencing the accuracy of IWPC prediction model in Chinese Han elderly patients with oral warfarin

Objective To explore the related factors that affect the accuracy of international warfarin phamacogenetics consortium(IWPC)prediction model in the patients aged≥75 years old receiving warfarin,and to provide a reference for reasonable usage of warfarin.Methods The clinical data of the patients aged≥75 years old receiving warfarin were collected.According to the difference rate between the predicted dose and the actual dose,the patients were divided into mild difference group(42 cases),moderate difference group(21 cases),significant difference group(10 cases).The clinical indicators of each group,including gender,age,body mass index,blood pressure,heart rate,comorbidities and concomitant medication were compared,and the influencing factors were analyzed.Results There were no significant differences in sex,age,liver function index and genotype distribution among the three groups(P>0.05).The history of heart failure and the proportion of diuretics used in the mild difference group were significantly lower than those in the significant difference group,and the serum creatinine of mild difference group was significantly lower and the estimated glomerular filtration rate(eGFR)was significantly higher than that in the moderate difference group and the significant difference group(P<0.05).History of heart failure and diuretics showed no significant effects on the dosage of warfarin(P>0.05).According to the quartile,eGFR was divided into low level[<59.5 mL/(min·1.73m^2)],middle-low level[59.5~76.3 mL/(min·1.73m^2)],middle-high level[76.4~96.5 mL/(min·1.73m^2)]and high level[>96.5 mL/(min·1.73m^2)]group.The difference between the actual and predicted dose of warfarin caused by the low level of eGFR was 4.455 times of that of the high level of eGFR;The difference between the actual and predicted dose of warfarin caused by the middle-low level of eGFR was 5.135 times higher than that of the high level of eGFR.Conclusions The average actual stable dose of warfarin in the patients aged≥75 years old of Han Chinese is less than 2.5 mg/d,the lower of the actual dose,the greater of the difference with the predicted dose by IWPC model formula,and there is a significant correlation between eGFR and dose difference.