What is the role of stroke anticoagulation in recurrent thrombosis?

Updated: Dec 18, 2018
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Patients with recurrent thrombotic events despite warfarin pose a challenge for clinicians. The INR at the time of recurrence is important; an INR below the target therapeutic range represents inadequate anticoagulation as opposed to warfarin failure.

These patients may be treated in the same manner as a patient presenting with new thrombosis without warfarin.

Possible treatment options for recurrent thrombosis despite an INR in the target range include increasing the intensity of warfarin anticoagulation to achieve a higher target INR (target INR, 2.5-3.5 or 3.0-4.0), switching from warfarin to therapeutic doses of unfractionated heparin or low-molecular weight heparin, or adding an antiplatelet agent to warfarin. [49]

Because the lupus anticoagulants may interfere with INR determination, monitoring these patients using the prothrombin-proconvertin time and the chromogenic factor-X assay would be preferable. However, these tests are expensive and are not widely available.

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