Journal «Angiology and Vascular Surgery» • 

2016 • VOLUME 22 • №3

Coagulological aspects of treatment of complications of prolonged therapy with warfarin

Krylov A.Yu.1, Shulutko A.M.1, Prasolov N.V.2, Petrovskaya A.A.1, Khmyrova S.E.1

1) Chair of Faculty Surgery No2 of the Therapeutic Department, First Moscow State Medical University named after I.M. Sechenov,
2) Haematological Scientific Centre of the Ministry of Healthcare of the Russian Federation, Moscow, Russia

The authors analysed the results of treating a total of 116 patients (68 men and 48 women aged from 20 to 84 years, mean age 59.5±15.5 years) presenting with various complications of prolonged therapy with warfarin. Prescription of prolonged therapy with warfarin had been caused by various cardiac diseases and lower extremity deep vein thromboses. The duration of anticoagulant therapy at the time of onset of complications was different and depended on the underlying disease. The majority of patients included into the study had been taking warfarin for one year and more, with nearly half of patients (48.1%) – for more than 5 years. Examination of patients included clinical, instrumental and laboratory studies, among which we determined standard laboratory parameters of haemostasis [activated partial thromboplastin time (APTT), international normalised ratio (INR), prothrombin index, prothrombin time, thrombin time, fibrinogen, etc.] and global tests (the thrombodynamics test and thromboelastogram).

Amongst complications of prolonged warfarin therapy, 10 patients were found to have various thrombotic complications and 106 patients were diagnosed as having various by localisation and intensity haemorrhage.

The obtained results of the study have demonstrated that the appearance of any thrombotic complications takes place occurs on the background of insufficient hypocoagulation and often require only correction of warfarin therapy. Whereas floating thrombi developing on the background of inadequate warfarin therapy require surgical management. Once haemorrhagic complications have developed, beside appropriate correction of warfarin therapy it is necessary to carry out correction of coagulopathies, which is done by means of different drugs and therapeutic regimens, whose choice should be based on assessing the clinical findings (localization and severity of haemorrhage) and laboratory indices, the main of which are local coagulologic tests, as well as global tests. The thrombodynamics test proved highly efficient for assessing the state of plasma haemostasis and predicting danger of the development of venous thromboembolic complications in patients with lower extremity deep vein thrombosis on the background of hyper- and hypocoagulation.

KEY WORDS: prolonged warfarin therapy, complications, thrombosis, haemorrhage, thrombodynamics, thromboelastogram.

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