scholarly journals Probable Interaction Between Warfarin and the Combination of Remdesivir With Dexamethasone for Coronavirus Disease 2019 (COVID-19) Treatment: A 2 Case Report

2021 ◽  
pp. 089719002110086
Author(s):  
Ronald Patrick Landayan ◽  
Sampson Saint-Felix ◽  
Ashley Williams
Keyword(s):  
Warfarin Therapy ◽  
International Normalized Ratio ◽  
Patient Specific ◽  
Potential Drug Interaction ◽  
Potential Drug ◽  
Specific Goal ◽  
Admission Interview ◽  
Male Patients ◽  
Probable Interaction

Purpose: To describe a potential drug interaction between warfarin and the combination of remdesivir with dexamethasone. Summary: Two male patients, a 71-year-old and 62-year-old presented to the emergency department for symptoms of coronavirus disease 2019 (COVID-19). Both patients were on long-term warfarin therapy with their most recent international normalized ratio (INR) prior to admission within their patient specific goal as managed by their outpatient Pharmacist. In both instances, the patients denied any changes in diet, lifestyle, or missed doses of medications upon admission interview. During admission, both patients experienced a marked elevation in INR within 24 to 48 hours of the initiation of remdesivir with dexamethasone for COVID-19 pneumonia directed therapy. The patients were both eventually stable and were instructed to continue warfarin monitoring and management under the direction of their outpatient Pharmacist upon discharge. Conclusion: The underrecognized but probable interaction between warfarin in conjunction with remdesivir and dexamethasone warrants further analysis.

Fenofibrate Potentiates Warfarin Effects

2003 ◽  
Vol 37 (2) ◽  
pp. 212-215 ◽  
Author(s):  
Karissa Y Kim ◽  
Michael A Mancano
Keyword(s):  
White Woman ◽  
Chart Review ◽  
Warfarin Therapy ◽  
Dosage Reduction ◽  
International Normalized Ratio ◽  
Drug Regimen ◽  
Warfarin Dosage ◽  
Therapeutic Doses ◽  
Anticoagulant Response

OBJECTIVE: To describe 2 patients in whom the initiation of fenofibrate potentiated warfarin's anticoagulant effects. CASE SUMMARY: A 71-year-old white woman and an 80-year-old white woman with multiple medical conditions were both stabilized on long-term warfarin therapy. During the course of anticoagulation, both patients were prescribed fenofibrate and experienced threefold and twofold increases in international normalized ratio (INR), respectively, requiring total weekly warfarin dosage reductions of 30–40%. Before starting fenofibrate therapy, both patients' coagulation values were within the therapeutic range. When interviewed, patients and caregivers denied bleeding, bruising, changes in diet, alcohol ingestion, nonadherence with therapy, or changes in drug regimen except for the addition of fenofibrate. Upon chart review, evaluation of potentially contributory parameters, such as other changes in drug therapy, thyroid function, liver function, and drug–disease interactions, showed that these parameters remained stable and were ruled noncontributory. DISCUSSION: The addition of fenofibrate in 2 patients on stable and therapeutic doses of warfarin increased the anticoagulant response to warfarin. A clear temporal relationship with the addition of fenofibrate and the appearance of the interaction was seen. Fenofibrate is highly protein bound, with the potential to displace warfarin from its binding protein, leading to an enhanced hypoprothrombinemic effect. Fenofibrate is also a mild to moderate inhibitor of CYP2C9, the enzyme responsible for warfarin metabolism. The combination of these effects — displacement of warfarin by fenofibrate coupled with decreased metabolism of warfarin — may increase the anticoagulant response to warfarin. Using the Naranjo probability scale, these interactions were designated as probable. CONCLUSIONS: We suggest serial monitoring of INR and consider an empiric 20% reduction in warfarin dosage when fenofibrate is initiated, with the possibility for a greater warfarin dosage reduction based on INR results.

Risk Factors of Recurrent Bleedings at Therapeutic International Normalized Ratio in Patients on Long-Term Warfarin Therapy

Kardiologiia ◽  
2016 ◽  
Vol 2_2016 ◽  
pp. 40-46
Author(s):  
O.V. Moreva Moreva ◽  
E.S. Kropacheva Kropacheva ◽  
A.B. Dobrovolsky Dobrovolsky ◽  
E.V. Titaeva Titaeva ◽  
E.P. Panchenko Panchenko ◽  
...  
Keyword(s):  
Risk Factors ◽  
Warfarin Therapy ◽  
International Normalized Ratio

scholarly journals Does prophylactic antibiotic administration for tooth extraction affect PT-INR in patients taking warfarin?

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Eiji Iwata ◽  
Akira Tachibana ◽  
Junya Kusumoto ◽  
Naoki Takata ◽  
Takumi Hasegawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tooth Extraction ◽  
Warfarin Therapy ◽  
Prophylactic Antibiotic ◽  
International Normalized Ratio ◽  
Antibiotic Administration ◽  
Number Of Patients ◽  
Warfarin Treatment ◽  
Before And After

Abstract Background Various antibiotics and analgesics have been reported to interact with warfarin. Reports that investigate the effects of medication taken for just a few days during tooth extraction on the prothrombin time-international normalized ratio are rare. Methods A total of 110 patients receiving long-term stable warfarin therapy underwent tooth extraction without interruption of warfarin treatment. INR values were measured 1 month before the tooth extraction, the day of the extraction, and 1 week after the extraction. We investigated the changes in INR values between the day of extraction and 1 week after extraction, as well as the various risk factors for increases in INR values. Results Before and after tooth extraction, the number of patients taking cefcapene pivoxil, amoxicillin, and azithromycin was 57, 36, and 8, respectively. Nine patients were administered ampicillin before tooth extraction and received amoxicillin after their tooth extraction. One week after tooth extraction, the INR values increased beyond the therapeutic range in 3 out of 110 patients (2.7%). The INR values before tooth extraction in these three patients were close to 3.0. The INR value increased by more than twice as much in 1 out of 110 patients (0.9%). Conclusion Our results suggest that prophylactic antibiotic administration has little effect on INR values when patients on stable warfarin therapy undergo tooth extraction. Surgeons have to take attention if the patients whose INR values are close to 3.0 before their extraction.

scholarly journals Does prophylactic antibiotic administration for tooth extraction affect PT-INR in patients taking warfarin?

2020 ◽  
Author(s):  
Eiji Iwata ◽  
Akira Tachibana ◽  
Junya Kusumoto ◽  
Naoki Takata ◽  
Takumi Hasegawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tooth Extraction ◽  
Warfarin Therapy ◽  
Prophylactic Antibiotic ◽  
International Normalized Ratio ◽  
Antibiotic Administration ◽  
Number Of Patients ◽  
Warfarin Treatment ◽  
Before And After

Abstract Background: Various antibiotics and analgesics have been reported to interact with　warfarin. Reports that investigate the effects of medication taken for just a few days during tooth extraction on the prothrombin time-international normalized ratio (PT-INR) are rare.Methods: A total of 110 patients receiving long-term stable warfarin therapy underwent tooth extraction without interruption of warfarin treatment. INR values were measured one month before the tooth extraction, the day of the extraction, and one week after the extraction. We investigated the changes in INR values between the day of extraction and one week after extraction, as well as the various risk factors for increases in INR values.Results: Before and after tooth extraction, the number of patients taking cefcapene pivoxil, amoxicillin, and azithromycin was 57, 36, and 8, respectively. Nine patients were administered ampicillin before tooth extraction and received amoxicillin after their tooth extraction. One week after tooth extraction, the INR values increased beyond the therapeutic range in 3 out of 110 patients (2.7%). The INR values before tooth extraction in these three patients were close to 3.0. The INR value increased by more than twice as much in 1 out of 110 patients (0.9%).Conclusion: Our results suggest that prophylactic antibiotic administration has little effect on INR values when patients on stable warfarin therapy undergo tooth extraction. Surgeons have to take attention if the patients whose INR values are close to 3.0 before their extraction.

scholarly journals Does prophylactic antibiotic administration for tooth extraction affect PT-INR in patients taking warfarin?

2020 ◽  
Author(s):  
Eiji Iwata ◽  
Akira Tachibana ◽  
Junya Kusumoto ◽  
Naoki Takata ◽  
Takumi Hasegawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tooth Extraction ◽  
Warfarin Therapy ◽  
Prophylactic Antibiotic ◽  
International Normalized Ratio ◽  
Antibiotic Administration ◽  
Number Of Patients ◽  
Warfarin Treatment ◽  
Before And After

Abstract Background: Various antibiotics have been reported to interact with　warfarin. Reports to have investigated the effects of prophylactic antibiotic administration for tooth extraction in patients taking warfarin on the prothrombin time-international normalized ratio (PT-INR) are rare.Methods: A total of 110 patients receiving long-term stable warfarin therapy underwent tooth extraction without interruption of warfarin treatment. INR values were measured one month before the tooth extraction, the day of the extraction, and one week after the extraction. We investigated the changes of INR values between the day of extraction and one week after the extraction, as well as the various risk factors for increases in INR values.Results: Before and after tooth extraction, the number of patients taking cefcapene pivoxil, amoxicillin, and azithromycin was 57, 36, and 8, respectively. Nine patients were administered ampicillin before tooth extraction and received amoxicillin after their tooth extraction. One week after tooth extraction, the INR values increased beyond the therapeutic range in 3 out of 110 patients (2.7%). The INR values before tooth extraction in these three patients were close to 3.0. The INR value increased by more than twice as much in 1 of 110 patients (0.9%).Conclusion: Our results suggest that prophylactic antibiotic administration has little effect on their INR values when patients on stable warfarin therapy undergo tooth extraction. Surgeons have to take attention if the patients whose INR values are close to 3.0 before their extraction.

Implementation of a Simplistic Bivalirudin-Warfarin Transition Protocol Is Associated With Improved Achievement of INR Values Within the Therapeutic Range

2016 ◽  
Vol 50 (12) ◽  
pp. 1001-1008 ◽  
Author(s):  
Amber R. Rollins ◽  
Kathryn E. Smith ◽  
Wesley R. Zemrak
Keyword(s):  
Warfarin Therapy ◽  
International Normalized Ratio ◽  
Inclusion Criteria ◽  
Bleeding Events ◽  
Reversal Agents ◽  
Successful Transition ◽  
Transition Strategy ◽  
Anticoagulant Reversal ◽  
Wide Transition

Background: Transition from bivalirudin to long-term warfarin therapy is often difficult to execute due to bivalirudin prolongation of the international normalized ratio (INR), and literature to help guide this transition is extremely limited. Objective: To assess the transition from bivalirudin to warfarin after implementation of an institution-wide transition protocol. Methods: In this retrospective quasiexperimental study, adult patients receiving bivalirudin directly followed by warfarin for nonprocedural systemic anticoagulation were evaluated to determine the frequency of successful transition to warfarin. Participants were compared before (preprotocol) and after (postprotocol) the implementation of the transition protocol. Results: A total of 39 patients met inclusion criteria and were included in the analysis (preprotocol = 19; postprotocol = 20). The percentage of patients achieving a successful transition was significantly higher in the postprotocol group compared with the preprotocol group (80.0% vs 42.1%, P = 0.015). Bleeding events were similar between the 2 groups (23.1% vs 16.7%, P = 0.689). Withholding of warfarin doses or the use of anticoagulant reversal agents or blood transfusions for supratherapeutic INR levels, surgical procedures, or drop in hemoglobin was numerically lower in the postprotocol group compared with the preprotocol group (16.7% vs 46.2%, P = 0.202). Conclusion: Implementation of a simplistic bivalirudin-warfarin transition protocol significantly increased the frequency of therapeutic INR results on bivalirudin discontinuation. Additionally, patients treated according to this protocol were less likely to have warfarin doses withheld or require reversal agents. Larger studies testing this transition strategy are warranted.

scholarly journals Quality of Warfarin Therapy and Quality of Life are Improved by Self-Management for Two Years

2019 ◽  
Vol 119 (10) ◽  
pp. 1632-1641 ◽  
Author(s):  
Una Ørvim Sølvik ◽  
Elisabeth Løkkebø ◽  
Ann Helen Kristoffersen ◽  
Ellen Brodin ◽  
Maria Averina ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Warfarin Therapy ◽  
International Normalized Ratio ◽  
Vitamin K Antagonist ◽  
Self Management ◽  
Prospective Design ◽  
Conventional Management ◽  
Before And After

Background Studies from several countries show that self-management of vitamin K antagonist (e.g., warfarin) therapy reduce the risk of complications compared with conventional management. Objectives The aim of this study was to investigate the quality of warfarin management when patients were transferred from conventional management to self-management in Norway. In addition, quality of life (QoL) before and after 2 years of warfarin self-management was investigated. Materials and Methods The study was longitudinal with a retrospective and prospective design where 126 patients on conventional management of long-term warfarin therapy underwent a 21-week training program of warfarin self-management followed by 2 years of self-management. The outcomes of the study were time in therapeutic range (TTR), the variance of international normalized ratio (INR) values, extreme INR values (INR ≤ 1.5 and ≥ 5), complications, and QoL, comparing the 2-year period of the conventional management with the 2-year period with the self-management. Results The median TTR was higher during self-management compared with conventional management (78.1% vs. 65.9%, respectively, p < 0.001). In addition, self-management resulted in lower INR variance (0.22 vs. 0.33, p < 0.001), reduced percentage of extreme INR values (1.8% vs. 5.3%, p < 0.001), less complications (0% vs. 5.6%), and improved QoL (p < 0.001) compared with conventional management. Conclusion We used five different measures and found improved quality of warfarin self-management 2 years after patients were transferred from the conventional management.

Probable Interaction Between Warfarin and Inhaled and Oral Administration of Cannabis

2019 ◽  
Vol 33 (6) ◽  
pp. 915-918 ◽  
Author(s):  
Amy Hsu ◽  
Nathan A. Painter
Keyword(s):  
Case Reports ◽  
Middle Eastern ◽  
Signs And Symptoms ◽  
International Normalized Ratio ◽  
Cannabis Use ◽  
Bleeding Complications ◽  
Close Monitoring ◽  
Interaction Probability ◽  
Probable Interaction

Objective: To report a probable interaction between warfarin and edible cannabis that resulted in an elevated international normalized ratio (INR) without bleeding complications. Case Summary: A 35-year-old Middle Eastern male on warfarin long term with an INR goal of 2.5 (accepted range: 2.0-3.0). The patient has generally been stable on warfarin 10 mg daily from 2010 to 2018, until INR suddenly increased to 7.2 following 1 month of edible cannabis ingestion and cannabis smoking. Patient denied any signs and symptoms of bleeding. No other reasonable causes of the elevation in INR were apparent. The patient was advised to hold 2 doses of warfarin and discontinue cannabis use. The INR dropped below 4 upon discontinuation of cannabis with dose adjustments to warfarin. Discussion: The elevation in INR can be explained by the inhibition of CYP2C9 by cannabis use causing decreased metabolism of warfarin. The interaction between warfarin and cannabis was determined to be probable using the Horn Drug Interaction Probability Scale. Conclusions: There are no previous reports of interactions between edible cannabis and warfarin, with very few case reports describing the interaction with other forms of cannabis. Close monitoring of INR in patients with concomitant cannabis is recommended for proper warfarin management.

Levofloxacin and Warfarin Interaction

2002 ◽  
Vol 36 (10) ◽  
pp. 1554-1557 ◽  
Author(s):  
Cade B Jones ◽  
Susan E Fugate
Keyword(s):  
Binding Sites ◽  
Warfarin Therapy ◽  
Case Reports ◽  
Anticoagulation Therapy ◽  
Warfarin Dose ◽  
International Normalized Ratio ◽  
Minor Bleeding ◽  
Protein Binding Sites ◽  
Case Summary

OBJECTIVE: To report 4 cases of hypoprothrombotic response resulting from addition of levofloxacin therapy to chronic warfarin therapy and to review related literature to support or refute a warfarin—levofloxacin interaction. CASE SUMMARY: Four patients, 34–81 years old, were prescribed levofloxacin concomitantly with stable warfarin therapy. Three patients had a target international normalized ratio (INR) range of 2.0–3.0 and experienced an increase in INR to 3.5, 8.12, and 11.5 on days 11, 5, and 4 of a 10-day course of levofloxacin, respectively. The fourth patient experienced minor bleeding, with a slightly elevated INR on the second day of levofloxacin therapy that required up to a 19% warfarin dose reduction during levofloxacin treatment. DISCUSSION: An initial premarketing clinical trial concluded that levofloxacin had no effect on warfarin's pharmacokinetics and pharmacodynamic response. Two case reports have since documented an increase in INR in patients taking long-term warfarin on completion of levofloxacin therapy. Our case reports provide further evidence of a significant increase in INR observed during concomitant levofloxacin therapy. The proposed mechanism of this interaction is displacement of warfarin from protein binding sites, reduction in gut flora producing vitamin K, and decreased warfarin metabolism. CONCLUSIONS: Prolonged prothrombin response in patients undergoing chronic warfarin therapy has been well documented with many antibiotics, including fluoroquinolones. Recognition of newer antibiotics' effects on warfarin therapy is important to guide safe use and monitoring of anticoagulation therapy. Our case studies demonstrate significant elevations in INR values during and up to 1 day after levofloxacin therapy in patients undergoing stable warfarin therapy.

scholarly journals Renal function in patients receiving long-term warfarin therapy: A five-year prospective follow-up

2017 ◽  
Vol 89 (9) ◽  
pp. 78-86 ◽  
Author(s):  
O A Zemlyanskaya ◽  
E S Kropacheva ◽  
A B Dobrovolsky ◽  
E P Panchenko
Keyword(s):  
Renal Function ◽  
Prognostic Value ◽  
Filtration Rate ◽  
Warfarin Therapy ◽  
Vitamin K Antagonists ◽  
Antiplatelet Agents ◽  
International Normalized Ratio ◽  
Estimate Glomerular Filtration Rate

Aim. To investigate the prognostic value of renal function and to estimate glomerular filtration rate (GFR) changes during a 5-year follow-up of patients receiving warfarin therapy. Subjects and methods. 200 patients (124 men, 76 women) mainly from a group at high risk for thromboembolic events (mean CHA2DS2-VASc scores, 3.25±1.89) were examined. The patients’ mean age was 62.3±9.4 years; the follow-up period was 5 years. 74% of the patients received warfarin monotherapy (international normalized ratio (INR) 2.0 to 3.0); 36% took vitamin K antagonists in combination with one or two antiplatelet agents. The CKD-EPI formula was used to estimate GFR in all the patients at baseline and throughout the investigation once a year. Results. GFR less than 70.9 ml/min/1.73 m2 was found to be a predictor of fatal and nonfatal thrombotic events. The decreased GFR was unassociated with the development of major and clinically relevant hemorrhagic complications within 5 years of warfarin therapy. The initial decline in renal function (GFR

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