Safety of warfarin anticoagulation in patients with heparin-induced thrombocytopenia.
Chest
; 116(5): 1333-8, 1999 Nov.
Article
in En
| MEDLINE
| ID: mdl-10559096
ABSTRACT
OBJECTIVES:
Venous limb gangrene has been reported to occur after high warfarin doses in heparin-induced thrombocytopenia (HIT), and this observation has been used to exclude warfarin management in this condition. The outcome of patients receiving modest doses of warfarin was studied.DESIGN:
Retrospective study of 114 consecutive HIT patients who received diagnoses by platelet aggregometry; 51 of the 114 patients received warfarin.SETTING:
Tertiary-care medical center.RESULTS:
Thirty-five patients received warfarin for non-HIT indications, and 16 received warfarin for heparin-associated thrombosis. Warfarin was given to 23 patients (47%) 2.4 +/- 0.4 days prior to the onset of HIT, in 19 while receiving IV heparin for an overlap of 2.7 +/- 0.4 days. Twenty-eight patients (53%) received warfarin 2.8 +/- 1.0 days after the diagnosis of HIT. Patients received 11 +/- 1 doses of warfarin over 16 +/- 2 days, with a mean daily dose of 3.5 +/- 0.5 and a maximum dose of 9 +/- 0.5 mg. Prothrombin time at discharge was 17.3 +/- 0.4 s with a maximum of 22.8 +/- 0.8. The final international normalized ratio was 2.9 +/- 0. 3, and the maximum was 7.5 +/- 1.4. The minimum therapeutic range was reached in 59% of determinations. When compared to the 63 patients who did not receive warfarin, warfarin patients received more IV heparin (86% vs 41%; p < 0.001), open heart surgery (78% vs 43%; p < 0.001), and had a lower mortality (8% vs 43%; p < 0.001), but had no differences in thrombosis.CONCLUSIONS:
Modest doses of warfarin were not associated with a worse outcome in patients with HIT.
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Collection:
01-internacional
Database:
MEDLINE
Main subject:
Thrombocytopenia
/
Warfarin
/
Heparin
/
Fibrinolytic Agents
/
Anticoagulants
Type of study:
Observational_studies
/
Risk_factors_studies
Limits:
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Chest
Year:
1999
Document type:
Article
Affiliation country:
United States