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Safety of warfarin dosing in the intensive care unit following the Fontan procedure.

Publication ,  Journal Article
Thomas, CA; Taylor, K; Schamberger, MS; Rotta, AT
Published in: Congenital heart disease
July 2014

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.Retrospective chart review.Pediatric intensive care unit in a freestanding pediatric teaching hospital.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.Supratherapeutic INR values, interventions in warfarin dosing to address or prevent supratherapeutic INR values, major and minor bleeding episodes, and venous thromboembolic events.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, P = .037, respectively). There were no reported thrombi or thromboembolic events and the only clinically significant bleeding event occurred while the INR value was subtherapeutic.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.

Duke Scholars

Published In

Congenital heart disease

DOI

EISSN

1747-0803

ISSN

1747-079X

Publication Date

July 2014

Volume

9

Issue

4

Start / End Page

361 / 365

Related Subject Headings

  • Warfarin
  • Treatment Outcome
  • Time Factors
  • Thromboembolism
  • Retrospective Studies
  • Predictive Value of Tests
  • Postoperative Care
  • Male
  • International Normalized Ratio
  • Intensive Care Units, Pediatric
 

Citation

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Thomas, C. A., Taylor, K., Schamberger, M. S., & Rotta, A. T. (2014). Safety of warfarin dosing in the intensive care unit following the Fontan procedure. Congenital Heart Disease, 9(4), 361–365. https://doi.org/10.1111/chd.12151
Thomas, Christopher A., Kathryn Taylor, Marcus S. Schamberger, and Alexandre T. Rotta. “Safety of warfarin dosing in the intensive care unit following the Fontan procedure.Congenital Heart Disease 9, no. 4 (July 2014): 361–65. https://doi.org/10.1111/chd.12151.
Thomas CA, Taylor K, Schamberger MS, Rotta AT. Safety of warfarin dosing in the intensive care unit following the Fontan procedure. Congenital heart disease. 2014 Jul;9(4):361–5.
Thomas, Christopher A., et al. “Safety of warfarin dosing in the intensive care unit following the Fontan procedure.Congenital Heart Disease, vol. 9, no. 4, July 2014, pp. 361–65. Epmc, doi:10.1111/chd.12151.
Thomas CA, Taylor K, Schamberger MS, Rotta AT. Safety of warfarin dosing in the intensive care unit following the Fontan procedure. Congenital heart disease. 2014 Jul;9(4):361–365.
Journal cover image

Published In

Congenital heart disease

DOI

EISSN

1747-0803

ISSN

1747-079X

Publication Date

July 2014

Volume

9

Issue

4

Start / End Page

361 / 365

Related Subject Headings

  • Warfarin
  • Treatment Outcome
  • Time Factors
  • Thromboembolism
  • Retrospective Studies
  • Predictive Value of Tests
  • Postoperative Care
  • Male
  • International Normalized Ratio
  • Intensive Care Units, Pediatric