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Editorials |

A Stuck Pig—Even on Warfarin—Doesn’t Always Bleed

Craig S. Kitchens, MD (Gainesville, FL)
Author and Funding Information

System Director, Medical Service, North Florida/South Georgia Veterans Health System, and Professor and Vice-Chairman, Department of Medicine, University of Florida.

Correspondence to: Craig S. Kitchens, MD, Veterans Affairs Medical Center, 1601 SW Archer Road, Gainesville, FL 32608-1197



Chest. 1999;115(6):1492-1493. doi:10.1378/chest.115.6.1492
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As reported by Brickey and Lawlor in this issue of CHEST (see page 1667), a porcine experimental model was established to observe iatrogenic hemorrhage following transbronchial forceps biopsy (TBBx) in animals having a prolonged international normalized ratio (INR) as a result of receiving warfarin. Their porcine model has proved to be physiologically similar to the human cardiopulmonary vascular anatomy and physiology, as well as to the hemostatic system. In their first phase, these Air Force intensivists set out to determine at which INR level the animals bled following TBBx. In the second phase, they planned to determine what therapeutic maneuvers would be efficacious in the treatment and/or reversal of hemorrhage when that threshold INR level was reached and TBBx carried out. This was done in a manner in which the bronchoscopist was blinded to all therapeutic and laboratory data. Of interest to this hematologist, a preconceived notion had infiltrated its way into the design: Brickey and Lawlor were intuitively sure that there would be an answer to phase 1 which would permit them to move on soon to the more important phase 2.


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