Safety of Warfarin Dosing in the Intensive Care Unit Following the Fontan Procedure. (25th November 2013)

• Record Type: Journal Article
• Authors: Thomas, Christopher A.; Taylor, Kathryn; Schamberger, Marcus S.; Rotta, Alexandre T.
• Is Part Of: Congenital heart disease. Volume 9:Number 4(2014)
• Page Start: 361
• Page End: 365
• Publication Date: 2013-11-25
• Subjects: Congenital heart disease -- Periodicals; 616.1204305
• DOI: 10.1111/chd.12151
• Languages: English
• ISSNs: 1747-079X

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="chd12151-sec-0001" sec-type="section"> <title>Objective</title> <p>To determine the incidence of supratherapeutic international normalized ratio (INR) values in patients initiated on warfarin in the pediatric intensive care unit after the Fontan procedure.</p> </sec> <sec id="chd12151-sec-0002" sec-type="section"> <title>Design</title> <p>Retrospective chart review.</p> </sec> <sec id="chd12151-sec-0003" sec-type="section"> <title>Setting</title> <p>Pediatric intensive care unit in a freestanding pediatric teaching hospital.</p> </sec> <sec id="chd12151-sec-0004" sec-type="section"> <title>Patients</title> <p>Thirty‐two consecutive children with single ventricle physiology with an initial Fontan conversion. All were initiated on warfarin in the postoperative period while in the intensive care unit.</p> </sec> <sec id="chd12151-sec-0005" sec-type="section"> <title>Outcome Measures</title> <p>Supratherapeutic INR values, interventions in warfarin dosing to address or prevent supratherapeutic INR values, major and minor bleeding episodes, and venous thromboembolic events.</p> </sec> <sec id="chd12151-sec-0006" sec-type="section"> <title>Results</title> <p>Supratherapeutic INR values after warfarin initiation occurred in 12.5% (n = 4) of patients with an additional 6.3% (n = 2) requiring dose adjustments due to a rapidly increasing INR. Patients with a supratherapeutic INR were started on warfarin earlier compared with other patients (median postoperative day 2 vs. 5, <italic>P</italic> = .037, respectively). There were no reported thrombi or thromboembolic events and the only clinically significant bleeding event occurred while the INR value was subtherapeutic.</p> </sec> <sec id="chd12151-sec-0007" sec-type="section"> <title>Conclusions</title> <p>Patients undergoing the Fontan procedure may be more sensitive to warfarin dosing when initiated closer to the surgical procedure date. Despite this observation, warfarin appears to be a safe medication for use within the early postoperative period after the Fontan procedure when response to therapy is monitored closely. Clinicians should use caution when initiating warfarin before postoperative day 3 in patients undergoing an initial Fontan operation.</p> </sec> </abstract>