Safety of Warfarin Anticoagulation in Patients With Heparin-Induced Thrombocytopenia
| Autor: | Robert F. Quintos, Harry L. Messmore, William H. Wehrmacher, Diane E. Wallis |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Platelet Aggregation medicine.drug_class Critical Care and Intensive Care Medicine Fibrinolytic Agents Heparin-induced thrombocytopenia medicine Humans cardiovascular diseases Retrospective Studies Prothrombin time Gangrene medicine.diagnostic_test Heparin Platelet Count business.industry Anticoagulant Warfarin Anticoagulants Middle Aged medicine.disease Thrombocytopenia Thrombosis Surgery Treatment Outcome Anesthesia Prothrombin Time Female Safety Cardiology and Cardiovascular Medicine Complication business medicine.drug |
| Zdroj: | Chest. 116:1333-1338 |
| ISSN: | 0012-3692 |
| DOI: | 10.1378/chest.116.5.1333 |
| Popis: | 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.Retrospective study of 114 consecutive HIT patients who received diagnoses by platelet aggregometry; 51 of the 114 patients received warfarin.Tertiary-care medical center.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%; p0.001), open heart surgery (78% vs 43%; p0.001), and had a lower mortality (8% vs 43%; p0.001), but had no differences in thrombosis.Modest doses of warfarin were not associated with a worse outcome in patients with HIT. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|