Factors That Affect Rate of INR Decline After Warfarin Discontinuation

Background: Despite vast literature on warfarin, optimal strategies for temporarily discontinuing and restarting warfarin have not been established. to improve warfarin discontinuation pro- cesses, we investigated known medical and genetic factors that influence stable warfarin dose to determine how well they predict the time until patients become subtherapeutic after discon- tinuing warfarin. Methods: this was a retrospective cohort study of patients who temporarily discontinued war- farin before an elective procedure and had at least 2 international normalized ratio (inR) values available during the discontinuation period. Data abstracted included date of discontinuation, warfarin dose, inR values, body surface area, gender, age, indication for warfarin, current medications, egFR, and presence of bridging therapy with heparin. Dna variants were tested in cYP2c9, VkoRc1, and cYP4F2 genes. Subjects were excluded if they received vitamin k, fresh frozen plasma, or prothrombin complexes to reverse anticoagulation. asymptotic regression models were used to approximate decline in inR during warfarin clearance. Spearman correla- tions and kruskal-Wallis tests were used to characterize associations of model estimates with quantitative variables and for group comparisons, respectively. Results: other than the expected association with baseline inR, correlations of model param- eter estimates with clinical variables were generally weak and not statistically significant. the strongest associations with slope were with serum creatinine and egFR. there were no signifi-