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Adjusted Coagulation Dose Recommended to Achieve International Normalized Ratio of 2 to 2.5 for Deep Vein Thrombosis
A DGReview of :"Effects Of oral anticoagulation with various INR levels in deep vein thrombosis cases"
Current Controlled Trials in Cardiovascular Medicine
03/03/2004
By Mary Beth Nierengarten
For patients with deep vein thrombosis, ideal long-term oral anticoagulation with minimal complications may require dose adjustment to achieve an international normalised ratio (INR) of between 2.0 and 2.5.
The need for long-term oral anticoagulation in patients with deep vein thrombosis has led to the establishment of an INR to monitor the efficacy of and complications related to oral anticoagulation treatment. Many institutions now use INR to determine the appropriate dose, with low doses given in patients with INR values between 2.0 and 2.5 and high doses for INR values of 2.5 to 3.5.
Ufuk Yetkin, MD, Department of Cardiovascular Surgery, Izmir Ataturk Education and Research Hospital, Alsancak, Izmir, Turkey, and colleagues compared bleeding complications based on INR values achieved in 364 patients with venous thromboembolism of the lower extremities treated with oral anticoagulation between 1997 and 2003.
After 6 months of standardized oral anticoagulation, efficacy and bleeding complications were evaluated based on classifying patients according to INR values. The 192 in group 1 had INR values between 1.9 and 2.5 and the 172 patients in group 2 had INR values between 2.6. and 3.5.
During the 6-month study period, there were no deaths and no major cases of morbidity, including pulmonary embolism and recurrent deep vein thrombosis.
Bleeding complications occurred in 4 patients in group 1; 2 patients (1.04%) had minor complications (subconjunctival hemorrhage and epistaxis) and 2 (1.04%) had major complications (gastrointestinal bleeding and haemarthrosis). In group 2, 7 patients (4.06%) had minor bleeding complications (skin necrosis in 3, epistaxis in 3 and subconjunctival haemorrhage in 3) and 11 (6.3%) had major bleeding complications (gastrointestinal bleeding in 6, vaginal bleeding in 3, haemarthrosis in 1 and gluteal haematoma in 1).
Patients in group 2 had significantly more major and minor bleeding complications than patients in group 1.
The authors write that these data show that bleeding complications increase as INR values increase, suggesting that to minimise complications, the anticoagulant dose should be adjusted to achieve an INR between 2.0 and 2.5 in these patients.
Curr Control Trials Cardiovasc Med 2004 Feb 18;5:1:1.
"Effects Of oral anticoagulation with various INR levels in deep vein thrombosis cases"
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