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KMID : 0858420100120020048
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Korean Journal of Stroke
2010 Volume.12 No. 2 p.48 ~ p.53
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Comparison of 5 mg and 10 mg Loading Doses of Warfarin in the Initiation of Oral Anticoagulation for Acute Ischemic Stroke Patients
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Sunwoo Jun-Sang
Kwon Hyung-Min
Moon Hye-Jin
Nam Hyun-Woo
Lee Yong-Seok
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Abstract
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Background: In the initiation of oral anticoagulant, rapid achievement of therapeutic level without excessive anticoagulation is required, but unfortunately there have been few studies on warfarin initiation protocol in acute stroke patients. The objective of our study was to investigate the feasibility of warfarin initiation regimens for patients with acute ischemic stroke comparing two different loading doses.
Methods: We retrospectively analyzed the patients who admitted with acute cerebral infarction or transient ischemic attack between November 2007 and June 2009. A total of 67 patients were found to start anticoagulation with 10 mg or 5 mg of warfarin for the first two consecutive days. We assessed the time in days to a therapeutic international normalized ratio (INR) (≥2.0), the proportion of INR within 2.0 to 3.0, and functional and safety outcomes.
Results: Thirty patients received 10 mg of warfarin, and 37 patients received 5 mg. Baseline characteristics of both groups were similar. Time to therapeutic INR of 10 mg group was earlier about 0.7 day (3.96±1.16 vs. 4.70±0.92, P=0.008). The proportion of patients with therapeutic INR in 10 mg group was higher at day 3 (40.0% vs. 5.4%, P=0.001). The groups did not differ in the proportion of patients with INR greater than 3.0 (33.3% vs. 29.7%, P=0.752). There was only patient with one major bleeding in 5-mg group.
Conclusion: A 10 mg loading dose of warfarin produces more rapid achievement of therapeutic INR. Further prospective research is needed to establish the possible contribution of warfarin initiation regimen to the successful anticoagulation in patients with acute ischemic stroke.
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KEYWORD
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Acute stroke, Warfarin, International normalized ratio
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