Exclusion criteria were: warfarin use for less than two months prior to the cardiac surgery date undocumented or unclear pre-operative warfarin dose postoperative warfarin therapy lasting less than five days prior to discharge postoperative admission to the intensive care unit (ICU). Paul’s Hospital for cardiac surgery between 1 February 2012 and 4 February 2014, were on warfarin prior to cardiac surgery and achieved therapeutic anticoagulation, had warfarin therapy resumed postoperatively in hospital, and achieved INRs within the therapeutic range (as appropriate for the indication for warfarin) during hospitalisation. Patients were included if they were admitted to St. PopulationĮligible patients were identified through the pharmacy database and patient chart reviews. The need for informed consent was waived. This single-centre, retrospective chart review was approved by the Providence Health Care Research Ethics Board and by the Fraser Health Research Ethics Board (Providence Health Care Reference number UBC PHC H13-02182). The purpose of this study is to determine if there is a difference in warfarin dosage before and after cardiac surgery needed to achieve therapeutic anticoagulation. No studies have been published that quantify the difference, if any, in warfarin dosage needed to achieve therapeutic INR, specifically, before and after cardiac surgery. 3,4 It is important to optimise anticoagulation in post-cardiac surgery patients, and delays can lead to prolonged hospitalisations due to the above complications. Serious complications, such as postoperative thromboembolic and haemorrhagic events, are consequences of the cardiac surgery itself and under- and over-anticoagulation. Paul’s Hospital, it has been observed that the warfarin dosage needed to achieve therapeutic anticoagulation is often lower post-cardiac surgery, compared with the patient’s warfarin dose prior to cardiac surgery. 1 Warfarin is usually discontinued prior to cardiac surgery and subsequently re-initiated postoperatively to achieve the target therapeutic international normalised ratio (INR). Warfarin is an anticoagulant commonly used in atrial fibrillation, venous thromboembolism, prosthetic cardiac valve replacement and postoperative atrial fibrillation. In conclusion, there was no statistically significant difference in the warfarin dosage before and after cardiac surgery needed to achieve target INRs. The mean daily postoperative warfarin dose needed for achieving a therapeutic INR was 0.18 mg lower than the mean pre-operative dose (5.03 ± 2.10 vs.
Ninety-five patients were included in the study.
The primary outcome was the difference in warfarin dosage needed to achieve target INR before and after cardiac surgery. The aims of the study are to determine the difference in warfarin dosage requirements, before and after cardiac surgery, needed to achieve therapeutic anticoagulation.Ī single-centre, retrospective review was conducted from 2012 to 2014 in cardiac surgery patients who were on warfarin pre-operatively and who had warfarin therapy resumed postoperatively in hospital.
D elays in achieving target international normalised ratio (INR) with warfarin after cardiac surgery can lead to suboptimal outcomes.
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