Prolonged hospitalization because of inappropriate delay of warfarin therapy in deep venous thrombosis

Current anticoagulation practices of physicians in an academic medical center were examined by retrospective review of records of 26 patients admitted for uncomplicated deep venous thrombosis (DVT) between 1978 and 1982. Patients received intravenous heparin for an average of 11.5 +/- 2.8 days. Warfarin therapy was started on day 8.3 +/- 3.1 and therapeutic oral anticoagulation was achieved by day 14.5 +/- 4.5. Total hospital stay averaged 16.8 +/- 5.1 days. No patient received concurrent initiation of heparin and warfarin therapy and only two patients received warfarin before day 5. These findings are in contrast to anticoagulation practices in Great Britain and Scandinavia where concurrent initiation of heparin and warfarin has been common practice for many years. Such a regimen is safe and usually requires fewer days of hospitalization for DVT. We conclude that failure to start warfarin therapy on the first hospital day resulted in a costly and unnecessarily prolonged hospital stay.