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Warfarin dosage in postpartum women: a case-control study
Cath Brooks1, Jane M Rutherford, Jane Gould
1Department of Fetomaternal Medicine, School of Human Development, University Hospital, Queen's Medical Centre, Nottingham, UK.
Summary
Postpartum women require higher warfarin doses and more time to achieve therapeutic anticoagulation compared to non-pregnant women. A standardized dosing nomogram is recommended for warfarin management in postpartum patients.
Area of Science:
- Pharmacology
- Obstetrics and Gynecology
- Clinical Pharmacy
Background:
- Physiological changes in coagulation proteins persist postpartum.
- Clinical suspicion suggests postpartum women are harder to anticoagulate with warfarin.
Purpose of the Study:
- To investigate if postpartum women require different warfarin dosing than non-pregnant women.
- To compare warfarin anticoagulation difficulty between postpartum and non-pregnant women.
Main Methods:
- Retrospective case-control study at University Hospital, Nottingham.
- Compared 23 postpartum women with 23 age-matched non-pregnant controls on warfarin.
- Recorded warfarin doses and international normalized ratio (INR) from day 1 to 35.
Main Results:
- Postpartum women needed significantly longer duration and higher doses of warfarin to reach therapeutic INR (P < 0.05).
- Postpartum women required a higher maintenance warfarin dose.
- On day three, 79% of postpartum women were under-dosed compared to 57% of controls using a nomogram.
Conclusions:
- Postpartum women necessitate increased warfarin dosage for effective anticoagulation.
- A warfarin dosing nomogram is recommended for postpartum patients to ensure adequate anticoagulation.