Dataset Information

A factor VII-based method for the prediction of anticoagulant response to warfarin.

ABSTRACT: Warfarin dosing methods based on existing models for warfarin and the international normalised ratio (INR) give biased maintenance dose predictions at the upper and lower quantiles of dose requirements. The aim of this work is to propose a conceptually different approach to predict INR after warfarin dosing. Factor VII concentration was proposed as the principal driving force for the INR. The time to steady-state INR (tSS,INR) was determined based on the INR response to changes in factor VII concentrations following warfarin initiation, and from this the steady-state INR (INRSS) was derived. The proposed method requires timed, paired blood samples of INR and factor VII. At different simulated warfarin dose rates, the prediction error associated with the proposed method was shown to be within clinically acceptable limits for both the tSS,INR (±2 days) and INRSS (±0.2). The use of the method was demonstrated in two patients who were initiated with 5?mg of warfarin daily. The difference in predicted versus actual steady-state INR were 0.0 and -0.4. The proposed method represents a unique approach to predict the INR. It considers factor VII as the main driver for INR and provides valuable information about the time to steady state INR.

SUBMITTER: Ooi QX

PROVIDER: S-EPMC6089929 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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A factor VII-based method for the prediction of anticoagulant response to warfarin.

Ooi Qing-Xi QX Wright Daniel F B DFB Isbister Geoffrey K GK Duffull Stephen B SB

Scientific reports 20180813 1

Warfarin dosing methods based on existing models for warfarin and the international normalised ratio (INR) give biased maintenance dose predictions at the upper and lower quantiles of dose requirements. The aim of this work is to propose a conceptually different approach to predict INR after warfarin dosing. Factor VII concentration was proposed as the principal driving force for the INR. The time to steady-state INR (t<sub>SS,INR</sub>) was determined based on the INR response to changes in fac ...[more]

PMID: 30104739

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Project description:In this paper, a strain-intensity-factor-based method is proposed to calculate the fatigue crack growth under the fully reversed loading condition. A theoretical analysis is conducted in detail to demonstrate that the strain intensity factor is likely to be a better driving parameter correlated with the fatigue crack growth rate than the stress intensity factor (SIF), especially for some metallic materials (such as 316 austenitic stainless steel) in the low cycle fatigue region with negative stress ratios R (typically R = -1). For fully reversed cyclic loading, the constitutive relation between stress and strain should follow the cyclic stress-strain curve rather than the monotonic one (it is a nonlinear function even within the elastic region). Based on that, a transformation algorithm between the SIF and the strain intensity factor is developed, and the fatigue crack growth rate testing data of 316 austenitic stainless steel and AZ31 magnesium alloy are employed to validate the proposed model. It is clearly observed that the scatter band width of crack growth rate vs. strain intensity factor is narrower than that vs. the SIF for different load ranges (which indicates that the strain intensity factor is a better parameter than the stress intensity factor under the fully reversed load condition). It is also shown that the crack growth rate is not uniquely determined by the SIF range even under the same R, but is also influenced by the maximum loading. Additionally, the fatigue life data (strain-life curve) of smooth cylindrical specimens are also used for further comparison, where a modified Paris equation and the equivalent initial flaw size (EIFS) are involved. The results of the proposed method have a better agreement with the experimental data compared to the stress intensity factor based method. Overall, the strain intensity factor method shows a fairly good ability in calculating the fatigue crack propagation, especially for the fully reversed cyclic loading condition.

Project description:Background Reduced time in international normalized ratio therapeutic range (TTR) limits warfarin safety and effectiveness. In patients switched from warfarin to direct oral anticoagulants (DOACs), patient factors associated with low TTR could also increase risk of DOAC nonadherence. We investigated the relationship between warfarin TTR and DOAC adherence in warfarin-treated patients with atrial fibrillation switched to DOAC. Methods and Results Using data from the Veterans Health Administration, we identified patients with atrial fibrillation switched from warfarin to DOAC (switchers) or treated with warfarin alone (non-switchers). Logistic regression was used to evaluate association between warfarin TTR and DOAC adherence. We analyzed 128 605 patients (age, 71±9; 1.6% women; CHA2DS2-VASc 3.5±1.6); 32 377 switchers and 96 228 non-switchers. In 8016 switchers with international normalized ratio data to calculate 180-day TTR before switch, TTR was low (median 0.45; IQR, 0.26-0.64). Patients with TTR <0.5 were more likely to be switched to DOAC (odds ratio [OR],1.68 [95% CI,1.62-1.74], P<0.0001), as were those with TTR <0.6 or TTR <0.7. Proportion of days covered ≥0.8 was achieved by 76% of switchers at 365 days. In low-TTR individuals, proportion of days covered ≥0.8 was achieved by 70%, 72%, and 73% of switchers with TTR <0.5, 0.6, and 0.7, respectively. After multivariable adjustment, TTR <0.5 decreased odds of achieving 365-day proportion of days covered ≥0.8 (OR, 0.49; 0.43-0.57, P<0.0001), with similar relationships for TTR <0.6 and TTR <0.7. In non-switchers with TTR <0.5, long-term TTR remained low. Conclusions In patients with atrial fibrillation switched from warfarin to DOAC, most achieved adequate DOAC adherence despite low pre-switch TTRs. However, TTR trajectories remained low in non-switchers. Patients with low warfarin TTR more consistently achieved treatment targets after switching to DOACs, although adherence-oriented interventions may be beneficial.

Dataset Information

A factor VII-based method for the prediction of anticoagulant response to warfarin.

Publications

A factor VII-based method for the prediction of anticoagulant response to warfarin.

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