Key result
Unadjusted citrate in high hematocrit patients falsely elevates INR, driving under-anticoagulation and recurrent thrombosis.
Case Report (n=1)
Highlights a case of extensive thrombosis occurring in a patient with treated congenital heart disease despite maintaining a therapeutic INR on warfarin.
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Thrombosis despite therapeutic INR warrants caution in congenital heart disease; case report leaves open need for prospective anticoagulation studies.
There has been significant progress in the management of venous thromboembolism in recent years, with increased awareness and adequate thromboprophylaxis proving successful in reducing the morbidity and mortality associated with this condition. Most hospitals in the UK have specialists who run an anticoagulation clinic and ensure the adequate monitoring of, and compliance with, agents such as warfarin. In this Lesson of the Month, we describe an individual with treated congenital heart disease who developed extensive thrombosis while his warfarin control was considered to be in the therapeutic range.
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Carroll et al. (2013) conducted a case report in Cyanotic congenital heart disease with recurrent thrombosis (n=1). Unadjusted citrate coagulation testing was evaluated on Artifactually elevated INR leading to recurrent thrombosis. Unadjusted citrate in coagulation tubes for a patient with high haematocrit caused an artifactually elevated INR, leading to under-anticoagulation and recurrent thrombosis.
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