BIOMAT Database Logo BIOMAT Database Logo

Relationship between elevated bilirubin levels and enhanced warfarin effects during biliary obstruction. 2023

Takafumi Nakazawa, and Shingo Yamazaki, and Masashi Uchida, and Takaaki Suzuki, and Takako Nakamura, and Masayuki Ohtsuka, and Itsuko Ishii
Division of Pharmacy, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba-Shi, Chiba, 260-8677, Japan.

OBJECTIVE A marked prolongation of the prothrombin time-international normalized ratio (PT-INR) is frequently observed during biliary obstruction in patients using warfarin. The objective of this study was to identify factors associated with PT-INR prolongation during biliary obstruction in patients using warfarin. METHODS Among 44 patients using warfarin who had biliary obstruction, we retrospectively investigated warfarin doses and laboratory data before and during biliary obstruction. The primary outcome was the association between changes in PT-INR (ΔPT-INR) and changes in laboratory data before and during biliary obstruction. RESULTS Median PT-INR was 1.59 (IQR 1.38-1.95) before biliary obstruction and 2.27 (IQR 1.60-3.49) during biliary obstruction, indicating significant prolongation during the obstruction (P < 0.001). ΔPT-INR showed strong positive correlations with change in total bilirubin (ΔT-Bil; ρ = 0.692, P < 0.001) and change in conjugated bilirubin (ΔC-Bil; ρ = 0.731, P < 0.001). ΔPT-INR showed a weak negative correlation with the change in albumin (ΔAlb; ρ =  -0.371, P < 0.05). When ΔPT-INR was used as the dependent variable in multiple linear regression analysis, ΔT-Bil, ΔC-Bil, and ΔAlb were significantly associated with ΔPT-INR. CONCLUSIONS PT-INR was prolonged during biliary obstruction in patients using warfarin, and changes in bilirubin levels were associated with ΔPT-INR. If biliary obstruction with markedly elevated bilirubin levels occurs, measuring PT-INR could lead to safer warfarin therapy.

UI MeSH Term Description Entries
D011517 Prothrombin Time Clotting time of PLASMA recalcified in the presence of excess TISSUE THROMBOPLASTIN. Factors measured are FIBRINOGEN; PROTHROMBIN; FACTOR V; FACTOR VII; and FACTOR X. It is used for monitoring anticoagulant therapy with COUMARINS. Quick Test,Russell's Viper Venom Time,Thrombotest,Russell Viper Venom Time,Russells Viper Venom Time,Prothrombin Times,Test, Quick,Time, Prothrombin,Times, Prothrombin
D001778 Blood Coagulation Disorders Hemorrhagic and thrombotic disorders that occur as a consequence of abnormalities in blood coagulation due to a variety of factors such as COAGULATION PROTEIN DISORDERS; BLOOD PLATELET DISORDERS; BLOOD PROTEIN DISORDERS or nutritional conditions. Coagulation Disorders, Blood,Disorders, Blood Coagulation,Blood Coagulation Disorder,Coagulation Disorder, Blood,Disorder, Blood Coagulation
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000925 Anticoagulants Agents that prevent BLOOD CLOTTING. Anticoagulant Agent,Anticoagulant Drug,Anticoagulant,Anticoagulant Agents,Anticoagulant Drugs,Anticoagulation Agents,Indirect Thrombin Inhibitors,Agent, Anticoagulant,Agents, Anticoagulant,Agents, Anticoagulation,Drug, Anticoagulant,Drugs, Anticoagulant,Inhibitors, Indirect Thrombin,Thrombin Inhibitors, Indirect
D001663 Bilirubin A bile pigment that is a degradation product of HEME. Bilirubin IX alpha,Bilirubin, (15E)-Isomer,Bilirubin, (4E)-Isomer,Bilirubin, (4E,15E)-Isomer,Bilirubin, Calcium Salt,Bilirubin, Disodium Salt,Bilirubin, Monosodium Salt,Calcium Bilirubinate,Hematoidin,delta-Bilirubin,Bilirubinate, Calcium,Calcium Salt Bilirubin,Disodium Salt Bilirubin,Monosodium Salt Bilirubin,Salt Bilirubin, Calcium,delta Bilirubin
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D014859 Warfarin An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. 4-Hydroxy-3-(3-oxo-1-phenylbutyl)-2H-1-benzopyran-2-one,Aldocumar,Apo-Warfarin,Coumadin,Coumadine,Gen-Warfarin,Marevan,Tedicumar,Warfant,Warfarin Potassium,Warfarin Sodium,Potassium, Warfarin,Sodium, Warfarin
D019934 International Normalized Ratio System established by the World Health Organization and the International Committee on Thrombosis and Hemostasis for monitoring and reporting blood coagulation tests. Under this system, results are standardized using the International Sensitivity Index for the particular test reagent/instrument combination used. INR,International Normalized Ratios,Normalized Ratio, International,Normalized Ratios, International,Ratio, International Normalized,Ratios, International Normalized

Related Publications

Takafumi Nakazawa, and Shingo Yamazaki, and Masashi Uchida, and Takaaki Suzuki, and Takako Nakamura, and Masayuki Ohtsuka, and Itsuko Ishii
Elevated carcinoembryonic antigen levels and biliary tract obstruction.
July 1975, JAMA,
Takafumi Nakazawa, and Shingo Yamazaki, and Masashi Uchida, and Takaaki Suzuki, and Takako Nakamura, and Masayuki Ohtsuka, and Itsuko Ishii
The relationship between bilirubin levels and atherosclerosis.
January 2015, Angiology,
Takafumi Nakazawa, and Shingo Yamazaki, and Masashi Uchida, and Takaaki Suzuki, and Takako Nakamura, and Masayuki Ohtsuka, and Itsuko Ishii
Relationship between neonatal adrenomedullin and bilirubin levels.
January 2014, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians,
Takafumi Nakazawa, and Shingo Yamazaki, and Masashi Uchida, and Takaaki Suzuki, and Takako Nakamura, and Masayuki Ohtsuka, and Itsuko Ishii
Relationship between biliary excretion of bilirubin and glutathione disulfide.
April 1993, Gastroenterologia Japonica,
Takafumi Nakazawa, and Shingo Yamazaki, and Masashi Uchida, and Takaaki Suzuki, and Takako Nakamura, and Masayuki Ohtsuka, and Itsuko Ishii
Experimental biliary obstruction: effect of thorotrast on lymph and serum bilirubin levels.
April 1962, The American journal of physiology,
Takafumi Nakazawa, and Shingo Yamazaki, and Masashi Uchida, and Takaaki Suzuki, and Takako Nakamura, and Masayuki Ohtsuka, and Itsuko Ishii
[Biliary elimination of bromsulphalein and of bilirubin during experimental partial obstruction].
January 1961, Revue internationale d'hepatologie,
Takafumi Nakazawa, and Shingo Yamazaki, and Masashi Uchida, and Takaaki Suzuki, and Takako Nakamura, and Masayuki Ohtsuka, and Itsuko Ishii
Relationship between serum bilirubin levels and optic neuritis.
January 2013, Chinese medical journal,
Takafumi Nakazawa, and Shingo Yamazaki, and Masashi Uchida, and Takaaki Suzuki, and Takako Nakamura, and Masayuki Ohtsuka, and Itsuko Ishii
Relationship between serum bilirubin levels and cardiovascular disease.
January 2018, PloS one,
Takafumi Nakazawa, and Shingo Yamazaki, and Masashi Uchida, and Takaaki Suzuki, and Takako Nakamura, and Masayuki Ohtsuka, and Itsuko Ishii
Patients with biliary atresia have elevated direct/conjugated bilirubin levels shortly after birth.
December 2011, Pediatrics,
Takafumi Nakazawa, and Shingo Yamazaki, and Masashi Uchida, and Takaaki Suzuki, and Takako Nakamura, and Masayuki Ohtsuka, and Itsuko Ishii
The relationship between biliary secretion of bilirubin and glutathione in the rat.
June 1992, Gastroenterologia Japonica,
Copied contents to your clipboard!