Related factors and safety of reaching the therapeutic target of warfarin after heart valve surgery in hospitalized patients: A retrospective cohort study

Warfarin is a commonly employed anticoagulant drug aimed at rapidly reaching the optimal international normalized ratio (INR), potentially reducing the hospitalization time in clinical settings. However, limited research has been conducted on the influencing factors and the safety implications of promptly reaching the target INR range in patients with valvular heart disease who have undergone valve replacement or repair. The present study aimed to assess the factors related to the safety considerations of rapidly reaching the target INR range in patients treated with warfarin. A retrospective cohort investigation was performed on hospitalized patients treated with warfarin between July 2022 and June 2023. Patient data were gathered from patient documentation. A total of 175 patients were included in the current study. The mean time to reach an effective INR threshold was 9.8 days (median, 3-28 days). Age >65 years, body mass index <24 kg/m², no smoking history and warfarin starting dose ≥3 mg/day were separate factors linked to rapidly reaching the effective INR threshold for warfarin management. The occurrence of INR levels ≥4 was significantly elevated among patients who reached the effective INR threshold more rapidly, while bleeding incidents were not significantly different. Inpatients aged >65 years, those with a body mass index <24 kg/m², no smoking history or prescribed a starting warfarin dosage ≥3 mg/day had a higher likelihood of rapidly reaching the effective INR threshold with warfarin. To enhance safety for these patients, enhanced INR tracking and suitable warfarin dosage adjustments are suggested following the initiation of oral warfarin therapy.