0
Clinical Investigations: CLOTTING |

Safety of Warfarin Anticoagulation in Patients With Heparin-Induced Thrombocytopenia*

Diane E. Wallis, MD, FCCP; Robert Quintos, MD; William Wehrmacher, MD; Harry Messmore, MD
Author and Funding Information

*From Midwest Heart Specialists, Ltd. (Dr. Wallis), Downers Grove, IL; and Loyola University Medical Center (Drs. Quintos, Wehrmacher, and Messmore), Maywood, IL.

Correspondence to: Diane E. Wallis, MD, FCCP, Midwest Heart Research Foundation, 2340 Highland Ave, Suite 310, Lombard, IL 60148



Chest. 1999;116(5):1333-1338. doi:10.1378/chest.116.5.1333
Text Size: A A A
Published online

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.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543