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Impact of regular physical activity on weekly warfarin dose requirement.

ABSTRACT: Warfarin is an oral anticoagulant agent with a narrow therapeutic index. There is a marked inter- and intra-patient variability in warfarin dose requirement. All factors influencing warfarin response are not known and this study aims to evaluate if regular physical activity (RPA) is a determining factor. RPA level was collected with the Stanford Brief Activity Survey in 1064 incident warfarin users, as part of the Quebec Warfarin Cohort (QWC), and with the Global Physical Activity Questionnaire in 618 patients from the Montreal Heart Institute (MHI) Biobank. Linear regression was performed to model relationship of warfarin dose after 3 months of therapy in the QWC with RPA, while controlling for height, weight, age, CYP2C9 (*2 and *3 alleles) and VKORC1 (*2 allele) genotype. Warfarin dose of prevalent users was modeled in the MHI Biobank for replication. A higher level of physical activity was associated with higher doses of warfarin in both cohorts. In the QWC, physical activity could explain 5.4 % (P < 0.001) and 0.9 % (P = 3.23 × 10(-5)) of variance in dose, in univariate and multivariable models, respectively. Similarly, RPA was found to be associated with 1.7 % (P = 0.0012) and 0.5 % (P = 0.0391) of inter-individual variability in warfarin dose requirement before and after adjustment for other covariables, respectively. RPA is associated with higher warfarin dose requirement. The relevance of clinical recommendations on RPA to maintain a steady response to warfarin should be assessed in further studies.

SUBMITTER: Rouleau-Mailloux E

PROVIDER: S-EPMC4735233 | biostudies-literature | 2016 Feb

REPOSITORIES: biostudies-literature

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Impact of regular physical activity on weekly warfarin dose requirement.

Rouleau-Mailloux Étienne É Shahabi Payman P Dumas Stéphanie S Feroz Zada Yassamin Y Provost Sylvie S Hu Jason J Nguyen Jacqueline J Bouchama Nawal N Mongrain Ian I Talajic Mario M Tardif Jean-Claude JC Perreault Sylvie S Dubé Marie-Pierre MP

Journal of thrombosis and thrombolysis 20160201 2

Warfarin is an oral anticoagulant agent with a narrow therapeutic index. There is a marked inter- and intra-patient variability in warfarin dose requirement. All factors influencing warfarin response are not known and this study aims to evaluate if regular physical activity (RPA) is a determining factor. RPA level was collected with the Stanford Brief Activity Survey in 1064 incident warfarin users, as part of the Quebec Warfarin Cohort (QWC), and with the Global Physical Activity Questionnaire ...[more]

PMID: 26238769

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Project description:BACKGROUND:Physical activity (PA) in adolescence is crucial for lifelong healthy lifestyle, and attention is needed to adolescents at health risk due to insufficient PA. This study investigates the composition of weekly PA in adolescents by PA level and provides a rationale for change in their lifestyles. METHODS:The research was conducted at 66 schools in Poland between 2009 and 2016, among 949 girls and 650 boys aged 15-18?years. We used pedometers to monitor weekly PA with data assessed using the Indares web app. The participants were split into three groups by mean daily step count (lower, < 9000; middle, 9000-12,999; and higher, ? 13,000 steps/day), as a reliable and non-expensive indicator of PA. RESULTS:We did not observe statistically significant differences in composition of 7-day PA between participants with varying levels of PA, regardless of their gender (F(12,9558)?=?0.60; p?=?0.841; ?p2?>?0.000). The smallest differences in daily step counts by PA level were found on Mondays and the biggest on Fridays and Saturdays, in boys and girls; the differences between average school and average weekend days were most pronounced in less active girls (1677 steps/day) and boys (1886 steps/day). During the school week, the highest proportion of less active girls met the 11,000 steps/day recommendation on Fridays (21.9%), statistically significantly less than on other school days (p?<?0.001). Similarly, less active boys (22.2%) had significantly less activity on Fridays than on other school days, except for Mondays (p?=?0.143) Analogous pattern was apparent also in more active adolescents. CONCLUSIONS:Less active adolescents have comparable composition of weekly PA to the more active ones but they can hardly meet the generally accepted PA recommendations. Better understanding of weekly PA composition and rates of meeting PA recommendations by day of the week can lead to more efficient interventions improving lifestyles. The recommendation of 9000 steps/day most days of the week, thus, appears appropriate for less active adolescents, as a motivating achievable goal.

Project description:BACKGROUND:The anticoagulation of atrial fibrillation catheter ablation during the perioperative stage does matter and should be treated with discretion. We aimed to assess impact of three important genes participating in vitamin K cycle (i.e. VKORC1 rs9923231, CYP4F2 rs2108622 and NQO1 rs1800566) on the daily stable warfarin dose requirement in Sichuan Han Chinese patients with catheter ablation of atrial fibrillation. METHODS:A total of 222 atrial fibrillation patients taking stable warfarin therapy after catheter ablation operation were enrolled in this study. The study population included had high (?2) risk according to the CHA2DS2-VASc risk score. Genotypes of VKORC1 rs9923231, CYP4F2 rs2108622 and NQO1 rs1800566 were analyzed by using the polymerase chain reaction restriction fragment length polymorphism method (PCR-RFLP). Multiple linear regression analysis was applied to depict the impact of VKORC1 rs9923231, CYP4F2 rs2108622 and NQO1 rs1800566 on the daily stable warfarin dose requirement. RESULTS:Carriers of VKORC1 rs9923231 AG/GG genotypes required significantly higher warfarin dose (3.03?±?0.28 mg/day, 7.19 mg/day, respectively) than AA carriers (2.52?±?0.07 mg/day; P <?0.001). Carriers of CYP4F2 rs2108622 CT/TT genotypes required significantly higher warfarin dose (3.38?±?0.22 mg/day, 2.79?±?0.19 mg/day, respectively) than CC carriers (2.41?±?0.08 mg/day; P?<?0.001). However, the warfarin dose for carriers of NQO1 rs1800566 CT/TT genotypes (2.46?±?0.24 mg/day, 3.01?±?0.27 mg/day, respectively) was not significantly higher than that for the CC carriers (2.33?±?0.1 mg/day). The multiple linear regression model including genotypes and demographic characteristics, could explain 20.1% of individual variations in the daily stable warfarin dose in Sichuan Han Chinese. VKORC1 rs9923231 contributed most (15%) to the individual variations in daily stable warfarin dose, while CYP4F2 rs2108622 contributed least (3%). CONCLUSION:NQO1 rs1800566 is not a significant genetic factor of warfarin dose for Han Chinese, whereas VKORC1 rs9923231 and CYP4F2 rs2108622 are significant genetic factors, which could explain 15% and approximately 3% of individual variations in the daily stable warfarin dose respectively.

Dataset Information

Impact of regular physical activity on weekly warfarin dose requirement.

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Impact of regular physical activity on weekly warfarin dose requirement.

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