Loading dose vs. maintenance dose of warfarin for reinitiation after invasive procedures: a randomized trial
- Authors
- Schulman, S.; Hwang, H. -G.; Eikelboom, J. W.; Kearon, C.; Pai, M.; Delaney, J.
- Issue Date
- Aug-2014
- Publisher
- Blackwell Publishing Inc.
- Keywords
- anticoagulation; bleeding; D-dimer; international normalized ratio; surgery
- Citation
- Journal of Thrombosis and Haemostasis, v.12, no.8, pp 1254 - 1259
- Pages
- 6
- Journal Title
- Journal of Thrombosis and Haemostasis
- Volume
- 12
- Number
- 8
- Start Page
- 1254
- End Page
- 1259
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/12012
- DOI
- 10.1111/jth.12613
- ISSN
- 1538-7933
1538-7836
- Abstract
- Background: There is uncertainty regarding the optimal dosing regimen for the resumption of warfarin after interruption for invasive procedures. Aim: To determine the efficacy and safety of warfarin resumption with loading doses or with the most recent maintenance dose. Methods: Patients receiving warfarin treatment and planned for invasive procedures with an expected hospital stay of <= 1 day were randomized to resume warfarin on the day of the procedure, defined as day 1, with most recent maintenance dose or with 2 initial days of double maintenance dose. Efficacy outcomes were proportion of international normalized ratio (INR) levels >= 2.0 on day 5 (primary outcome) and day 10. Safety outcomes were bleeding and thromboembolic events. In addition, D-dimer levels were analyzed on days 5 and 10 in a subset of the population. Results: There were 49 patients analyzed in each group. INR of >= 2.0 had been achieved by day 5 for 13% in the maintenance-dose group and for 50% in the loading-dose group (relative risk [RR] 0.27, 95% confidence interval [CI] 0.10-0.60) and by day 10 for 68% and 87%, respectively (RR 0.78, 95% CI 0.65-1.00). There were no thromboembolic events, and there was one major bleed before resumption of warfarin and one minor bleed, both in the maintenance-dose group. There was no difference between the groups in the proportion of patients with excessive INRs or elevated D-dimer levels or in the median D-dimer level. Conclusion: Resumption of warfarin after minor-moderately invasive procedures with two loading doses achieves therapeutic INR faster than does only maintenance dose.
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Collections - College of Medicine > Department of Internal Medicine > 1. Journal Articles
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