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Published on: February 28, 2012

Warfarin anticoagulation after congenital heart surgery at a large children's hospital

Adam W Lowry1, Brady S Moffett, Douglas Moodie

  • 1Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, 77030, USA.

Pediatric Cardiology
|May 17, 2012
PubMed

Insights

Warfarin management after pediatric heart surgery is challenging. This study found that while it took a median of 2 days to reach therapeutic anticoagulation, adverse events were uncommon, suggesting warfarin is generally well-tolerated in these patients.

Area of Science:

  • Pediatric Cardiology
  • Pharmacology
  • Clinical Therapeutics

Background:

  • Warfarin anticoagulation is crucial for some pediatric patients post-congenital heart surgery.
  • Limited data exist on warfarin initiation and associated risks in this specific population.

Purpose of the Study:

  • To determine the time to achieve therapeutic anticoagulation (INR ≥ 2) with warfarin post-cardiac surgery.
  • To identify risk factors for supratherapeutic anticoagulation (INR ≥ 4) and adverse events.

Main Methods:

  • Retrospective review of 59 pediatric patients receiving warfarin after cardiac surgery (2006-2011).
  • Analysis of factors influencing time to INR ≥ 2 and risk of INR ≥ 4.

Main Results:

  • Median time to achieve INR ≥ 2 was 2 days (IQR, 2-4).
  • Delayed warfarin initiation and concurrent heparin use prolonged time to therapeutic INR.
  • Nine patients had INR ≥ 4; no thrombotic events occurred, and significant bleeding was rare.

Conclusions:

  • Warfarin is generally well-tolerated in pediatric patients after cardiac surgery.
  • Adverse events, including supratherapeutic anticoagulation, were uncommon.
  • Time to therapeutic anticoagulation was relatively short, with specific factors identified for delay.

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