LETTER
Monitoring Warfarin Therapy in Patients with Lupus Anticoagulants
Arumugam Manoharan, MD
15 March 1998 | Volume 128 Issue 6 | Page 504
TO THE EDITOR:
Moll and Ortel [1] raise an important clinical management issue: Use of international normalized ratios may not be a reliable way to monitor warfarin therapy in some patients with lupus anticoagulants. In a report published 20 years ago [2], my colleagues and I documented the use of the "Thrombotest" [3] in a patient with lupus anticoagulant. Because this test measured overall clotting activity and the result was expressed as percentage of activity [4], we thought that it was better for monitoring oral anticoagulant therapy than the conventional prothrombin time in patients with lupus anticoagulants. Can Drs. Moll and Ortel please comment on the value of this test in comparison with the chromogenic factor X assay and the prothrombin-proconvertin assay, discussed in their article?
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Author and Article Information
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St. George Hospital; Kogarah, Sydney, Australia
1. Moll S, Ortel TL. Monitoring warfarin therapy in patients with lupus anticoagulants. Ann Intern Med. 1997; 127:177-85.
2. Manoharan A, Gibson L, Rush B, Feery BJ. Recurrent venous thrombosis with a "lupus" coagulation inhibitor in the absence of systemic lupus. Aust N Z J Med. 1977; 7:422-6.
3. Owren PA. Thrombotest. A new method for controlling anticoagulant therapy. Lancet. 1959; 2:754-8.
4. Pitney WR. Oral anticoagulants. In: Clinical Aspects of Thromboembolism. London: Churchill Livingstone; 1972:80-107.
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