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A re-appraisal of Warfarin control in the treatment of Deep Vein Thrombosis and / or Pulmonary Embolism
Abstract
Background: Warfarin is commonly used for management of deep vein thrombosis (DVT) and pulmonary embolism (PE), controlling therapy by means of the International Normalized Ratio (INR). Objectives: To identify differences in INR results between patients with thromboembolic and haemorrhagic complications and controls. Methods: Two nested case-control studies from within a controlled trial of the duration of warfarin therapy (47 thrombotic and16 haemorrhagic complications). Results: Patients whose thromboembolism failed to resolve during treatment or recurred during or after treatment had non-significantly lower INR levels than matched controls (geometric mean 2.2 versus 2.3, p = 0.12). Patients with haemorrhage also had not statistically significant lower INR levels than their matched controls (2.1 versus 2.3, p = 0.22). The variability of INR levels was similar in both case groups and controls.
The mean percentage of INR levels in the therapeutic range 2 3 was almost identical in thrombotic cases and controls (56.5% versus 56.1%). Compared to the haemorrhagic group, better control was achieved in
controls (61.5% versus 43.0%, p =0.01), but controls had slightly more INR values above the therapeutic range (12.1% versus 10.5%, p = 0.74) whilst haemorrhagic cases had more INR values below the therapeutic
range (46.6% versus 26.4%, p = 0.03). Conclusion: In this study, higher INR levels were not associated with haemorrhage suggesting that, for
patients being treated for DVT/PE, a modest increase in the target therapeutic range could be considered.
Running head: Warfarin Control in treatment of DVT/PE
Key words: Deep vein thrombosis; Haemorrhage; International normalized ratio; Pulmonary embolism; Thromboembolism; Warfarin.
African Health Sciences 2009; 9(3): 179-185
