Co-Authors:
Lubetsky, A., Department of Medicine A, Sheba Medical Center, Tel Hashomer, Israel, Institute of Hematology, Ichilov Hospital, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Seligsohn, U., Department of Medicine A, Sheba Medical Center, Tel Hashomer, Israel, Institute of Hematology, Ichilov Hospital, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Ezra, D., Department of Medicine A, Sheba Medical Center, Tel Hashomer, Israel, Institute of Hematology, Ichilov Hospital, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Halkin, H., Department of Medicine A, Sheba Medical Center, Tel Hashomer, Israel, Institute of Hematology, Ichilov Hospital, Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Abstract:
Objective: Determination of the effects of the vitamin K—dependent anticoagulants, proteins C and S, on warfarin dose requirements and on the prediction error of a bayesian warfarin dose predicting program. Methods: Patients in the study were consecutive inpatients (n = 18) starting treatment with warfarin who were monitored as outpatients for 4 weeks. The following measurements were taken: repeated (n = 8) prothrombin times, expressed as the international normalized ratio (INR), plasma protein C and S antigen levels (percentage of pooled normal plasma), demographic, clinical and biochemical variables. Results: Maintenance doses (adjusted to INR 2.5) were 6.7 ± 3.4 mg/day. Protein C decreased to 56.9% ± 15.3%, protein S to 63.7% ± 17.3%, INR increased to 2.46 ± 0.14. Prediction error decreased from 2.84 ± 2.0 mg/day to 0.95 ± 0.78 mg/day. Protein C accounted for only 4.2% of the mean maintenance dose but protein C and S levels accounted for 31% of the mean dose prediction error. Conclusion: Protein C and S levels affect warfarin doses and predictions significantly but not to a clinically meaningful degree. Clinical Pharmacology and Therapeutics (1992) 52, 42–49; doi: © 1992 American Society for Clinical Pharmacology and Therapeutics
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