Key result
Warfarin patients develop ischemic stroke despite severely elevated INR of ~11.
Case Report (n=2)
No
This case report highlights the rare occurrence of ischemic stroke in patients on warfarin despite having significantly supratherapeutic INR levels, contrary to the typical expectation of bleeding.
Ischemic stroke may occur at supratherapeutic INR on warfarin; case reports leave open mechanisms and require prospective study.
Warfarin is a vitamin K antagonist commonly used in the treatment and prevention of thromboembolic cases worldwide. Its therapeutic range is narrow and is followed by the international normalized ratio (INR). Ischemic conditions are observed at low INR levels whereas bleeding is seen at higher INR levels. A 45-year-old woman and a 79-year-old man using warfarin were admitted to the emergency department with a neurological deficit. Ischemic stroke was revealed via radiological imaging in both patients. However, INR levels were significantly higher in laboratory tests (11.44 and 12.37 kU / L).Ischemic stroke occurred although bleeding is normally expected at such high INR levels. Contrary to many studies published in the literature, this case report revealed interesting information in terms of its conclusions.
No takes yet. Share an insight, caveat, or question.
Yüksel et al. (2022) conducted a case report in Ischemic stroke (n=2). Warfarin was evaluated on Ischemic stroke occurrence. Two patients on warfarin therapy developed ischemic stroke despite having significantly high INR levels of 11.44 and 12.37 kU/L, which are typically associated with bleeding risk.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: