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Relationship between elevated bilirubin levels and enhanced warfarin effects during biliary obstruction
Objectives A marked prolongation of the prothrombin time-international normalized ratio (PT-INR) is frequently observed during biliary obstruction in patients using warfarin. The objective of this study was to identify factors associated with PT-INR prolongation during biliary obstruction in patient...
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| Published in: | European journal of clinical pharmacology 2023-03, Vol.79 (3), p.437-443 |
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| container_end_page | 443 |
| container_issue | 3 |
| container_start_page | 437 |
| container_title | European journal of clinical pharmacology |
| container_volume | 79 |
| creator | Nakazawa, Takafumi Yamazaki, Shingo Uchida, Masashi Suzuki, Takaaki Nakamura, Takako Ohtsuka, Masayuki Ishii, Itsuko |
| description | Objectives
A marked prolongation of the prothrombin time-international normalized ratio (PT-INR) is frequently observed during biliary obstruction in patients using warfarin. The objective of this study was to identify factors associated with PT-INR prolongation during biliary obstruction in patients using warfarin.
Methods
Among 44 patients using warfarin who had biliary obstruction, we retrospectively investigated warfarin doses and laboratory data before and during biliary obstruction. The primary outcome was the association between changes in PT-INR (ΔPT-INR) and changes in laboratory data before and during biliary obstruction.
Results
Median PT-INR was 1.59 (IQR 1.38–1.95) before biliary obstruction and 2.27 (IQR 1.60–3.49) during biliary obstruction, indicating significant prolongation during the obstruction (
P
|
| doi_str_mv | 10.1007/s00228-023-03459-7 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2771637637</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2771637637</sourcerecordid><originalsourceid>FETCH-LOGICAL-c392t-838e32b696c1b9c922523aac159fc421b4e028cc603fd911448d9509dcdf1bd93</originalsourceid><addsrcrecordid>eNp9kUtLxDAQx4Mouj6-gAcpePFSnWT6ylHEFwiC6DnkMd2tdNs1aRW_vanrAzwIgSGZ3_wzM3_GDjmccoDyLAAIUaUgMAXMcpmWG2zGMxQph4xvshkA8rSQJeyw3RCeAXguAbfZDhalwDKvZmz-QK0emr4Li2aVGBreiLqEWnrVA7nENG3jR9N0SXyhNiS6cwl1C93ZmH3TvtY-JqmuyQ4hcWO8zT-rtH9PehMGP9pJfp9t1boNdPAV99jT1eXjxU16d399e3F-l1qUYkgrrAiFKWRhuZFWCpEL1NrGxmubCW4yAlFZWwDWTnKeZZWTOUhnXc2Nk7jHTta6K9-_jBQGtWyCpbbVHfVjUKIseYFlPBE9_oM-96PvYncTVXFEqIpIiTVlfR-Cp1qtfLOM0ykOarJBrW1Q0Qb1aYOapI--pEezJPdT8r33COAaCKtpY-R___5H9gOlzZPA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2778133086</pqid></control><display><type>article</type><title>Relationship between elevated bilirubin levels and enhanced warfarin effects during biliary obstruction</title><source>Springer Nature</source><creator>Nakazawa, Takafumi ; Yamazaki, Shingo ; Uchida, Masashi ; Suzuki, Takaaki ; Nakamura, Takako ; Ohtsuka, Masayuki ; Ishii, Itsuko</creator><creatorcontrib>Nakazawa, Takafumi ; Yamazaki, Shingo ; Uchida, Masashi ; Suzuki, Takaaki ; Nakamura, Takako ; Ohtsuka, Masayuki ; Ishii, Itsuko</creatorcontrib><description>Objectives
A marked prolongation of the prothrombin time-international normalized ratio (PT-INR) is frequently observed during biliary obstruction in patients using warfarin. The objective of this study was to identify factors associated with PT-INR prolongation during biliary obstruction in patients using warfarin.
Methods
Among 44 patients using warfarin who had biliary obstruction, we retrospectively investigated warfarin doses and laboratory data before and during biliary obstruction. The primary outcome was the association between changes in PT-INR (ΔPT-INR) and changes in laboratory data before and during biliary obstruction.
Results
Median PT-INR was 1.59 (IQR 1.38–1.95) before biliary obstruction and 2.27 (IQR 1.60–3.49) during biliary obstruction, indicating significant prolongation during the obstruction (
P
< 0.001). ΔPT-INR showed strong positive correlations with change in total bilirubin (ΔT-Bil;
ρ
= 0.692,
P
< 0.001) and change in conjugated bilirubin (ΔC-Bil;
ρ
= 0.731,
P
< 0.001). ΔPT-INR showed a weak negative correlation with the change in albumin (ΔAlb;
ρ
= −0.371,
P
< 0.05). When ΔPT-INR was used as the dependent variable in multiple linear regression analysis, ΔT-Bil, ΔC-Bil, and ΔAlb were significantly associated with ΔPT-INR.
Conclusions
PT-INR was prolonged during biliary obstruction in patients using warfarin, and changes in bilirubin levels were associated with ΔPT-INR. If biliary obstruction with markedly elevated bilirubin levels occurs, measuring PT-INR could lead to safer warfarin therapy.</description><identifier>ISSN: 0031-6970</identifier><identifier>EISSN: 1432-1041</identifier><identifier>DOI: 10.1007/s00228-023-03459-7</identifier><identifier>PMID: 36723758</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Anticoagulants - therapeutic use ; Bilirubin ; Biomedical and Life Sciences ; Biomedicine ; Blood Coagulation Disorders ; Humans ; International Normalized Ratio ; Laboratories ; Pharmacology/Toxicology ; Prothrombin ; Prothrombin Time ; Retrospective Studies ; Warfarin ; Warfarin - therapeutic use</subject><ispartof>European journal of clinical pharmacology, 2023-03, Vol.79 (3), p.437-443</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c392t-838e32b696c1b9c922523aac159fc421b4e028cc603fd911448d9509dcdf1bd93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36723758$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nakazawa, Takafumi</creatorcontrib><creatorcontrib>Yamazaki, Shingo</creatorcontrib><creatorcontrib>Uchida, Masashi</creatorcontrib><creatorcontrib>Suzuki, Takaaki</creatorcontrib><creatorcontrib>Nakamura, Takako</creatorcontrib><creatorcontrib>Ohtsuka, Masayuki</creatorcontrib><creatorcontrib>Ishii, Itsuko</creatorcontrib><title>Relationship between elevated bilirubin levels and enhanced warfarin effects during biliary obstruction</title><title>European journal of clinical pharmacology</title><addtitle>Eur J Clin Pharmacol</addtitle><addtitle>Eur J Clin Pharmacol</addtitle><description>Objectives
A marked prolongation of the prothrombin time-international normalized ratio (PT-INR) is frequently observed during biliary obstruction in patients using warfarin. The objective of this study was to identify factors associated with PT-INR prolongation during biliary obstruction in patients using warfarin.
Methods
Among 44 patients using warfarin who had biliary obstruction, we retrospectively investigated warfarin doses and laboratory data before and during biliary obstruction. The primary outcome was the association between changes in PT-INR (ΔPT-INR) and changes in laboratory data before and during biliary obstruction.
Results
Median PT-INR was 1.59 (IQR 1.38–1.95) before biliary obstruction and 2.27 (IQR 1.60–3.49) during biliary obstruction, indicating significant prolongation during the obstruction (
P
< 0.001). ΔPT-INR showed strong positive correlations with change in total bilirubin (ΔT-Bil;
ρ
= 0.692,
P
< 0.001) and change in conjugated bilirubin (ΔC-Bil;
ρ
= 0.731,
P
< 0.001). ΔPT-INR showed a weak negative correlation with the change in albumin (ΔAlb;
ρ
= −0.371,
P
< 0.05). When ΔPT-INR was used as the dependent variable in multiple linear regression analysis, ΔT-Bil, ΔC-Bil, and ΔAlb were significantly associated with ΔPT-INR.
Conclusions
PT-INR was prolonged during biliary obstruction in patients using warfarin, and changes in bilirubin levels were associated with ΔPT-INR. If biliary obstruction with markedly elevated bilirubin levels occurs, measuring PT-INR could lead to safer warfarin therapy.</description><subject>Anticoagulants - therapeutic use</subject><subject>Bilirubin</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Blood Coagulation Disorders</subject><subject>Humans</subject><subject>International Normalized Ratio</subject><subject>Laboratories</subject><subject>Pharmacology/Toxicology</subject><subject>Prothrombin</subject><subject>Prothrombin Time</subject><subject>Retrospective Studies</subject><subject>Warfarin</subject><subject>Warfarin - therapeutic use</subject><issn>0031-6970</issn><issn>1432-1041</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kUtLxDAQx4Mouj6-gAcpePFSnWT6ylHEFwiC6DnkMd2tdNs1aRW_vanrAzwIgSGZ3_wzM3_GDjmccoDyLAAIUaUgMAXMcpmWG2zGMxQph4xvshkA8rSQJeyw3RCeAXguAbfZDhalwDKvZmz-QK0emr4Li2aVGBreiLqEWnrVA7nENG3jR9N0SXyhNiS6cwl1C93ZmH3TvtY-JqmuyQ4hcWO8zT-rtH9PehMGP9pJfp9t1boNdPAV99jT1eXjxU16d399e3F-l1qUYkgrrAiFKWRhuZFWCpEL1NrGxmubCW4yAlFZWwDWTnKeZZWTOUhnXc2Nk7jHTta6K9-_jBQGtWyCpbbVHfVjUKIseYFlPBE9_oM-96PvYncTVXFEqIpIiTVlfR-Cp1qtfLOM0ykOarJBrW1Q0Qb1aYOapI--pEezJPdT8r33COAaCKtpY-R___5H9gOlzZPA</recordid><startdate>20230301</startdate><enddate>20230301</enddate><creator>Nakazawa, Takafumi</creator><creator>Yamazaki, Shingo</creator><creator>Uchida, Masashi</creator><creator>Suzuki, Takaaki</creator><creator>Nakamura, Takako</creator><creator>Ohtsuka, Masayuki</creator><creator>Ishii, Itsuko</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20230301</creationdate><title>Relationship between elevated bilirubin levels and enhanced warfarin effects during biliary obstruction</title><author>Nakazawa, Takafumi ; Yamazaki, Shingo ; Uchida, Masashi ; Suzuki, Takaaki ; Nakamura, Takako ; Ohtsuka, Masayuki ; Ishii, Itsuko</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c392t-838e32b696c1b9c922523aac159fc421b4e028cc603fd911448d9509dcdf1bd93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Anticoagulants - therapeutic use</topic><topic>Bilirubin</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Blood Coagulation Disorders</topic><topic>Humans</topic><topic>International Normalized Ratio</topic><topic>Laboratories</topic><topic>Pharmacology/Toxicology</topic><topic>Prothrombin</topic><topic>Prothrombin Time</topic><topic>Retrospective Studies</topic><topic>Warfarin</topic><topic>Warfarin - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nakazawa, Takafumi</creatorcontrib><creatorcontrib>Yamazaki, Shingo</creatorcontrib><creatorcontrib>Uchida, Masashi</creatorcontrib><creatorcontrib>Suzuki, Takaaki</creatorcontrib><creatorcontrib>Nakamura, Takako</creatorcontrib><creatorcontrib>Ohtsuka, Masayuki</creatorcontrib><creatorcontrib>Ishii, Itsuko</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of clinical pharmacology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nakazawa, Takafumi</au><au>Yamazaki, Shingo</au><au>Uchida, Masashi</au><au>Suzuki, Takaaki</au><au>Nakamura, Takako</au><au>Ohtsuka, Masayuki</au><au>Ishii, Itsuko</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Relationship between elevated bilirubin levels and enhanced warfarin effects during biliary obstruction</atitle><jtitle>European journal of clinical pharmacology</jtitle><stitle>Eur J Clin Pharmacol</stitle><addtitle>Eur J Clin Pharmacol</addtitle><date>2023-03-01</date><risdate>2023</risdate><volume>79</volume><issue>3</issue><spage>437</spage><epage>443</epage><pages>437-443</pages><issn>0031-6970</issn><eissn>1432-1041</eissn><abstract>Objectives
A marked prolongation of the prothrombin time-international normalized ratio (PT-INR) is frequently observed during biliary obstruction in patients using warfarin. The objective of this study was to identify factors associated with PT-INR prolongation during biliary obstruction in patients using warfarin.
Methods
Among 44 patients using warfarin who had biliary obstruction, we retrospectively investigated warfarin doses and laboratory data before and during biliary obstruction. The primary outcome was the association between changes in PT-INR (ΔPT-INR) and changes in laboratory data before and during biliary obstruction.
Results
Median PT-INR was 1.59 (IQR 1.38–1.95) before biliary obstruction and 2.27 (IQR 1.60–3.49) during biliary obstruction, indicating significant prolongation during the obstruction (
P
< 0.001). ΔPT-INR showed strong positive correlations with change in total bilirubin (ΔT-Bil;
ρ
= 0.692,
P
< 0.001) and change in conjugated bilirubin (ΔC-Bil;
ρ
= 0.731,
P
< 0.001). ΔPT-INR showed a weak negative correlation with the change in albumin (ΔAlb;
ρ
= −0.371,
P
< 0.05). When ΔPT-INR was used as the dependent variable in multiple linear regression analysis, ΔT-Bil, ΔC-Bil, and ΔAlb were significantly associated with ΔPT-INR.
Conclusions
PT-INR was prolonged during biliary obstruction in patients using warfarin, and changes in bilirubin levels were associated with ΔPT-INR. If biliary obstruction with markedly elevated bilirubin levels occurs, measuring PT-INR could lead to safer warfarin therapy.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>36723758</pmid><doi>10.1007/s00228-023-03459-7</doi><tpages>7</tpages></addata></record> |
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| subjects | Anticoagulants - therapeutic use Bilirubin Biomedical and Life Sciences Biomedicine Blood Coagulation Disorders Humans International Normalized Ratio Laboratories Pharmacology/Toxicology Prothrombin Prothrombin Time Retrospective Studies Warfarin Warfarin - therapeutic use |
| title | Relationship between elevated bilirubin levels and enhanced warfarin effects during biliary obstruction |
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