Warfarin therapy does not increase bleeding in patients undergoing heart transplantation

Background. Historically, warfarin has been discontinued or rapidly reverse d with fresh frozen plasma in patients awaiting heart transplantation becau se of concerns regarding excessive bleeding. Because preoperative warfarin may have effects on bleeding after cardiac operations, we reviewed our expe rience to determine the risks in patients undergoing heart transplantation while maintained on warfarin. Methods. The records of consecutive adult patients undergoing heart transpl antation from January 1996 to December 1998 were reviewed. Preoperative and 24-hour postoperative data were obtained, including patient demographics; hematologic laboratory values; medication use; repeat or primary sternotomy data; allogeneic blood product administration; and chest tube drainage. Mu ltivariate linear and logistic regression analyses were performed using the se variables to determine risk factors for bleeding after heart transplanta tion. Results. Ninety adult patients, mean age 50 years, underwent orthotopic hea rt transplantation during the 36-month period. No relationships existed bet ween preoperative international normalized ratio (INR, mean = 1.83 +/- 0.1, p = 0.84) or postoperative INR (mean = 2.2 +/- 0.9, p = 0.63) and chest tu be drainage (mean = 721 +/- 63 mL). Relationships were observed between tot al blood product administration and preoperative INR (partial r = 0.30, p = 0.01) and postoperative INR (partial r = -0.37, p = 0.002); however, preop erative INR did not correlate (p = 0.29) when perioperative use of fresh fr ozen plasma was factored as a covariate. Inverse relationships were evident between postoperative INR and total blood product exposures, as well as tr ansfusions of platelets (partial r = -0.26, p = 0.03). fresh frozen plasma (partial r = - 0.28, p = 0.02), and red cells (partial r = -0.25, p = 0.04) . Conclusions. Although we noted no correlations between INR and chest tube o utput, inverse relationships were observed with transfusion requirements in the first 24 hours after transplantation. Preoperative warfarin may be saf ely continued in patients awaiting heart transplantation. (C) 2001 by The S ociety of Thoracic Surgeons.