A Review of Warfarin Dosing and Monitoring

Kuruvilla, Mariamma; Gurk-Turner, Cheryle

doi:10.1080/08998280.2001.11927781

Cited by 134 publications

(117 citation statements)

References 4 publications

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“…5 The present case raises concern about the possibility of developing recurrent thrombosis in patients diagnosed with PS deficiency within the current guidelines of the INR range between 2-3. [6][7][8] This seems to be a rare occurrence due to the lack of literature with similar cases, however there have been documented cases of patients with recurrent venous thrombosis despite optimal INR in cases of Anti-Phospholipid Syndrome (APS). 9 In the absence of guidelines for this situation, we decided that raising the therapeutic INR range from 2-3 to 3-4, keeping in mind the increased risk of bleeding with intracerebral hemorrhage being the most worrisome.…”

Section: Discussionmentioning

confidence: 99%

Deep venous thrombosis in a patient with therapeutic INR for PS deficiency

Vamegh¹,

Hallak²,

Abousherif³

2017

Int J Res Med Sci

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We have reported a rare case of DVT in a 25-year-old patient with a known case of Protein S deficiency with INR within therapeutic index. He was seen in the ED and transferred to the Medical ward after diagnosis in the ED using doppler US. The patient was successfully treated with heparin and warfarin with a higher than usual optimal INR. This case adds to the growing evidence that PS deficiency is one of the rare causes of DVT, and also raises awareness that thrombosis can still occur in the current optimal INR for such patients. This case report necessitates the revision of what should be the optimal INR for patients with Protein S deficiency who develop thrombosis in the current optimal INR.

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Section: Discussionmentioning

confidence: 99%

Deep venous thrombosis in a patient with therapeutic INR for PS deficiency

Vamegh¹,

Hallak²,

Abousherif³

2017

Int J Res Med Sci

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“…Warfarin is used to treat venous thrombosis. Its safety and efficacy depend on the administered dose, and an INR value of 2.0 -3.0 is recommended [5]. A dose of warfarin exceeding the recommended therapeutic range can cause bleeding as a complication.…”

Section: Discussionmentioning

confidence: 99%

“…Rarely, a spontaneous pseudoaneurysm of the deep femoral artery has developed without a clear history of trauma or orthopedic surgery of the femur under special conditions [3,4]. Warfarin is used to treat and prevent venous thrombosis, and the dose of warfarin should be adjusted to maintain the target international normal ratio (INR) [5]. INR values that exceed the therapeutic range lead to bleeding and other complications.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Rupture of a Deep Femoral Pseudoaneurysm Mimicking Lymphedema After Radical Hysterectomy in a Woman Who Was Receiving Warfarin

et al. 2016

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Pseudoaneurysms of the deep femoral artery have been reported after external injury to the thigh and orthopedic surgery of the femur. We describe our experience with a case of spontaneous rupture of a deep femoral pseudoaneurysm in a woman who was receiving warfarin within the therapeutic range. She received a choledocholithotomy after a radical hysterectomy for uterine cervical cancer (stage IB1). Pulmonary embolism and deep-vein thrombosis developed after choledocholithotomy, and an inferior vena cava filter was left in place permanently. She was receiving warfarin since then. This time, the patient presented with a pseudoaneurysm of the deep femoral artery and a large hematoma in the adductor muscle of the thigh. Swelling of the thigh in this condition resembled the lower-extremity edema that occurs after pelvic lymph-node dissection. Contrast-enhanced computed tomography (CT) was useful for diagnosis of the pseudoaneurysm and evaluation of the extent of muscle damage.

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“…The safety and efficacy of warfarin therapy are dependent on maintaining the international normalized ratio (INR) within the target range for the indication, which is between 2.0 and 3.0 in most clinical scenarios, like atrial fibrillation (AF) and prevention or treatment of venous thromboembolism. 1 There are several challenges in providing optimal anticoagulation in patients on warfarin therapy. Among these challenges, the narrow therapeutic index is perhaps one of the most important.…”

Section: Introductionmentioning

confidence: 99%