Effect of early or delayed administration of warfarin with heparin on thrombosis in pulmonary thromboembolism.
OBJECTIVE
The aim of this study was to investigate the effect of early or delayed warfarin administration with unfractionated heparin (UFH) on coagulation parameters in pulmonary thromboembolism (PTE).


METHODS
This study was performed between November 2006 and July 2007. Thirty-three patients with PTE were sequentially slotted to early (n = 16) and delayed (n = 17) warfarin treatment groups. In the early group, both UFH infusion and warfarin were started simultaneously and in the delayed group, warfarin was added (1-3 days later) based on when partial thromboplastin time reached the therapeutic level with UFH. The proteins C and S, D-dimer, hematocrit levels, and platelet counts for all patients were studied prior to treatment and 6, 24, and 48 h after warfarin treatment. In order to determine the overall effect of early and delayed warfarin treatment on clot formation, a thromboelastogram was performed simultaneously.


RESULTS
In both groups, a similar chronological decrease in protein C levels reaching maximum at 24 h with warfarin treatment was observed. However, intragroup or intergroup decreases in protein S levels were not different. On thromboelastogram, INTEM and EXTEM clotting times were significantly prolonged chronologically, but this prolongation was not different between groups.


CONCLUSIONS
The suppressor effect of warfarin on proteins C and S in the early period of double anticoagulant treatment did not appear to aggravate the risk of thrombosis in patients with PTE in whom warfarin was started simultaneously with UFH.
Department of Chest Diseases, School of Medicine, Karadeniz Technical University, Trabzon, Turkey.
Tevfik
T
Ozlu
Olcay
O
Aycicek
Mehmet
M
Sonmez
Yilmaz
Y
Bulbul
Serdar Bedii
SB
Omay
Funda
F
Oztuna
Ahmet
A
Durmus
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products; D006400:Hematocrit; D006801:Humans; D007902:Length of Stay; D008297:Male; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011486:Protein C; D017293:Protein S; D011655:Pulmonary Embolism / Q000188:drug therapy*; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013916:Thrombelastography; D013997:Time Factors; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use*
D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; D011486:Protein C; D017293:Protein S; C036309:fibrin fragment D; D014859:Warfarin