Abstract
Objective:The purpose of this study was to analyze the difference in duration of anticoagulation and dose of warfarin required to reach a therapeutic international normalized ratio [(INR) of 2 to 3] in patients with hypercoagulable conditions as compared to controls. To our knowledge, this study is the first in the literature to delineate such a difference.Materials and Methods:A retrospective chart review was performed in a tertiary care hospital. The total study population was 622. Cases (n=125) were patients with a diagnosis of a hypercoagulable syndrome who developed venous thromboembolism. Controls (n=497) were patients with a diagnosis of venous thromboembolism in the absence of a hypercoagulable syndrome and were matched for age, sex, and race.Results:The total dose of warfarin required to reach therapeutic INR in cases was higher (50.7±17.6 mg) as compared to controls (41.2±17.7 mg). The total number of days required to reach therapeutic INR in cases was 8.9±3.5 days as compared to controls (6.8±2.9 days). Both of these differences were statistically significant (p<0.001).Conclusion:Patients with hypercoagulable conditions require approximately 10 mg of additional total warfarin dose and also require, on average, 2 extra days to reach therapeutic INR as compared to controls.
Highlights
It has been well documented that both acquired and hypercoagulable conditions play an important role in thrombophilia development
There have been a few studies that have investigated warfarin dosing in specific hypercoagulable conditions, such as antiphospholipid antibodies and highversus low-intensity warfarin efficacy in recurrent deep vein thrombosis (DVT) prevention [3]
It is not known if a difference exists in the total dose and time of warfarin therapy necessary to reach a therapeutic international normalized ratio (INR) in patients with hypercoagulable conditions
Summary
It has been well documented that both acquired and hypercoagulable conditions play an important role in thrombophilia development. Once a patient develops venous thromboembolism (VTE), the main mode of treatment has been warfarin, with recent advent of newer medications such as rivaroxaban [2]. There have been a few studies that have investigated warfarin dosing in specific hypercoagulable conditions, such as antiphospholipid antibodies and highversus low-intensity warfarin efficacy in recurrent deep vein thrombosis (DVT) prevention [3]. It is not known if a difference exists in the total dose and time of warfarin therapy necessary to reach a therapeutic international normalized ratio (INR) in patients with hypercoagulable conditions. The goal of this study was to determine the difference in the time and dose of warfarin required to reach therapeutic INR (i.e. INR of 2 to 3) in patients with hypercoagulable conditions as compared to controls
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