Warfarin Dosing and Time Required to Reach Therapeutic International Normalized Ratio in Patients with Hypercoagulable Conditions [Turk J Hematol]
Turk J Hematol. 2016; 33(4): 299-303 | DOI: 10.4274/tjh.2015.0271  

Warfarin Dosing and Time Required to Reach Therapeutic International Normalized Ratio in Patients with Hypercoagulable Conditions

Pushpinderdeep Kahlon1, Shahzaib Nabi1, Adeel Arshad2, Absia Jabbar3, Ali Haythem4
1Wayne State University, Henry Ford Health System, Clinic of Internal Medicine, Detroit, USA
2Weill Cornell University, Hamad Medical Corporation, Clinic of Internal Medicine, Doha, Qatar
3Nishtar Hospital, University of Health Science, Multan, Pakistan
4Wayne State University, Henry Ford Health System, Clinic of Hematology-Oncology, Detroit, USA

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.

Keywords: International normalized ratio, Warfarin, Hypercoagulable conditions, Venous thromboembolism


Hiperkoagülabilite Durumları Olan Hastalarda Terapötik Uluslararası Düzeltme Oranına Ulaşmak için Gerekli Warfarin Doz ve Süresi

Pushpinderdeep Kahlon1, Shahzaib Nabi1, Adeel Arshad2, Absia Jabbar3, Ali Haythem4
1Wayne State University, Henry Ford Health System, Clinic of Internal Medicine, Detroit, USA
2Weill Cornell University, Hamad Medical Corporation, Clinic of Internal Medicine, Doha, Qatar
3Nishtar Hospital, University of Health Science, Multan, Pakistan
4Wayne State University, Henry Ford Health System, Clinic of Hematology-Oncology, Detroit, USA

Amaç: Bu çalışmanın amacı kontrollerle karşılaştırıldığında hiperkoagülabilite durumları olan hastalarda terapötik uluslararası düzeltme oranında (INR) 2 ile 3 aralığına ulaşmak için gerekli warfarin doz ve antikoagülan süresindeki farklılığı analiz etmektir. Bildiğimiz kadarıyla; bu farklılığı tarifleyen literatürdeki ilk çalışmadır.
Gereç ve Yöntem: Retrospektif dosya taraması 3. basamak hastanede yapıldı. Toplam çalışmaya alınan hasta sayısı 622 idi. Venöz tromboembolizmi olan bu hastalardan 125’inin hiperkoagülabilite sendromu olup yaş, cins ve etnik kökeni aynı 497 kontrol hastasında hiperkoagülabilite sendromu yoktu.
Bulgular: Hastalarda terapötik INR’ye ulaşmak için gerekli total warfarin dozu (50,7±17,6 mg) kontrollerin dozu (41,2±17,7 mg) ile karşılaştırıldığında yüksekti. Terapötik INR’ye ulaşmak için gerekli total gün sayısı hastalarda 8,9±3,5 gün olup kontrollerde 6,8±2,9 gün idi. Her iki karşılaştırmada da istatistiksel farklılık anlamlı bulundu (p<0,001).
Sonuç: Hiperkoagülabilite durumları olan hastalarda terapötik INR’ye ulaşmak için kontrollere göre yaklaşık 10 mg ek total warfarin dozu ve ortalama 2 ek gün gereklidir.

Anahtar Kelimeler: Uluslararası düzeltme oranı, Warfarin, Hiperkoagülabilite durumları, Venöz tromboembolizm


Pushpinderdeep Kahlon, Shahzaib Nabi, Adeel Arshad, Absia Jabbar, Ali Haythem. Warfarin Dosing and Time Required to Reach Therapeutic International Normalized Ratio in Patients with Hypercoagulable Conditions. Turk J Hematol. 2016; 33(4): 299-303

Corresponding Author: Shahzaib Nabi, United States


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