title: Subcutaneous low molecular weight heparin in place of heparin infusion during warfarin dose optimisation in cerebral ischaemia.
abstract: We explored the feasibility of using subcutaneous low-molecular-weight-heparin (LMWH) injections in place unfractionated heparin (UFH) while anticoagulating patients with cerebral ischemia. In this open-labeled, prospective study, patients admitted to our hospital with transient ischemic attacks or stroke requiring anticoagulation who were otherwise medically fit for discharge home were enrolled. The LMWH nadroparin (Fraxiparine) 4100 antiXa BID was administered. In those on UFH, this was stopped after the first dose of LMWH. Patients were sent home and LMWH was administered on an outpatient basis with simultaneous oral warfarin titration till INR reached 2.0. Fifteen patients (13 inpatients, two outpatients) were enrolled; 12 had stroke, one each had crescendo transient ischaemia attacks (TIAs) while on aspirin, TIAs and intracranial arterial stenosis, TIA and atrial fibrillation. Inpatients were discharged home within a median of 1 day (range 1-3 days). Median duration of LMWH therapy was 9 days (range 4-47 days); nine required LMWH for 10 days or less. Two patients reported bruising at the injection site. There was no death, cerebral ischaemia recurrence or major hemorrhage. Using LMWH in place of UFH in patients with cerebral ischaemia is a feasible and safe way of achieving optimal oral anticoagulation and can be done on an outpatient basis.
authors.affiliation: Department of Neurology, Tan Tock Seng Hospital, Singapore. ramani_nv@notes.ttsh.gov.sg
authors.forename: N
authors.initials: N
authors.lastname: Venketasubramanian
authors.forename: H C
authors.initials: HC
authors.lastname: Chua
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D002545:Brain Ischemia / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D007279:Injections, Subcutaneous; D002546:Ischemic Attack, Transient / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011446:Prospective Studies; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin