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Very Low Doses of Warfarin Can Prevent Thrombosis in Central Venous Catheters: A Randomized Prospective Trial

Murray M. Bern, MD; Jacob J. Lokich, MD; Sabina R. Wallach, MD; Albert Bothe Jr., MD; Peter N. Benotti, MD; Charles F. Arkin, MD; Frank A. Greco, MD; Mark Huberman, MD; and Cheryl Moore, RN
[+] Article, Author, and Disclosure Information

Grant Support: By Pharmacia-NuTech, Walpole, Massachusetts, and E.I. DuPont Company, Wilmington, Delaware.

Requests for Reprints: Murray Bern, MD, 125 Parker Hill Avenue, Boston, MA 02120.

Current Author Addresses: Drs. Bern, Lokich, and Wallach and Ms. Moore: 125 Parker Hill Avenue, Boston, MA 02120.

Drs. Bothe, Benotti, Arkin, and Huberman: 185 Pilgrim Road, Boston, MA 02215.

Dr. Greco: 3 Seminary Street, Charlestown, MA 02129.

Ann Intern Med. 1990;112(6):423-428. doi:10.7326/0003-4819-76-3-112-6-423
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Objective: To determine whether very low doses of warfarin are useful in thrombosis prophylaxis in patients with central venous catheters.

Design: Patients at risk for thrombosis associated with chronic indwelling central venous catheters were prospectively and randomly assigned to receive or not to receive 1 mg of warfarin, beginning 3 days before catheter insertion and continuing for 90 days. Subclavian, innominate, and superior vena cava venograms were done at onset of thrombosis symptoms or after 90 days in the study.

Results: One hundred twenty-one patients entered the study, and 82 patients completed the study. Of 42 patients completing the study while receiving warfarin, 4 had venogram-proven thrombosis. All 4 had symptoms from thrombosis. Of 40 patients completing the study while not receiving warfarin, 15 had venogram-proven thrombosis, and 10 had symptoms from thrombosis (P < 0.001). There were no measurable changes in the coagulation values assayed due to this warfarin dose, except in occasional patients who had become anorectic because of their disease or chemotherapy.

Conclusions: Very low doses of warfarin can protect against thrombosis without inducing a hemorrhagic state. This approach may be applicable to other groups of patients.





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