Abstract

BackgroundAmiodarone and warfarin are sometimes administered immediately after cardiac surgery. Although the interaction between long-term oral amiodarone and warfarin has been reported, the interaction between warfarin and short-term intravenous amiodarone has not been reported. In this study, we investigated the effect of short-term intravenous amiodarone on the anticoagulant effect of warfarin in patients who underwent cardiac surgery.MethodsWe retrospectively reviewed the medical records of 11 patients who received oral warfarin before and after cardiac surgery, and loading doses of 125–150 mg or a 750 mg continuous infusion of amiodarone, or both in the intensive care unit (ICU) within 5 days after the surgery between July 2011 and January 2017. The prothrombin time-international normalized ratio (PT-INR)/daily warfarin dose (PT-INR/dose) was used as an indicator of anticoagulant effect. The values before surgery were considered as the baseline.ResultsThe PT-INR and PT-INR/dose values were elevated in 7 and 10 patients, respectively, after amiodarone administration. The mean PT-INR values were not significantly different before and after amiodarone administration (2.13 ± 0.58 vs 2.29 ± 0.50, respectively, p = 0.643). In contrast, the mean PT-INR/dose values were significantly elevated after the administration of amiodarone (0.93 ± 0.46 vs 1.54 ± 0.63, respectively, p = 0.002).ConclusionsShort-term intravenous amiodarone enhanced the anticoagulant effect of warfarin in patients admitted to the ICU after cardiac surgery. We suggest that the dose of warfarin should be carefully adjusted for a few days after cardiac surgery if intravenous amiodarone is coadministered.

Highlights

  • Amiodarone and warfarin are sometimes administered immediately after cardiac surgery

  • In this study, we investigated the effect of short-term intravenous amiodarone on the anticoagulant effect of warfarin in patients admitted to the intensive care unit (ICU) after cardiac surgery

  • We focused on the effect of amiodarone injections administered for 1–3 day only on the anticoagulant effect of warfarin in patients admitted to the ICU after cardiac surgery

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Summary

Introduction

Amiodarone and warfarin are sometimes administered immediately after cardiac surgery. We investigated the effect of short-term intravenous amiodarone on the anticoagulant effect of warfarin in patients who underwent cardiac surgery. Controlling the dosage of warfarin in patients admitted to the intensive care unit (ICU) immediately after cardiac surgery can be especially. Amiodarone is known to induce drug-drug interactions with warfarin that could lead to excessive anticoagulation and bleeding risk [8–12]. Amiodarone is metabolized in the liver by Takase et al Journal of Pharmaceutical Health Care and Sciences (2018) 4:13 the drug-metabolizing enzyme cytochrome P450 (CYP), which it inhibits. The mechanism of the drug-drug interaction between warfarin and amiodarone is due to the inhibition of CYP. Amiodarone and its active metabolite “desethylamiodarone” inhibit CYP2C9, which increases the anticoagulation effect of warfarin [8]

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