Problems of anticoagulation with warfarin in hyperthyroidism

Q J Med. 1986 Jan;58(225):43-51.

Abstract

From clinical observation it would appear that hyperthyroid patients are particularly sensitive to the anticoagulant effects of warfarin. A study was made of clotting factors prothrombin (II), VII, procoagulant VIII (VIIIC), IX and X and of prothrombin ratio (PTR) and partial thromboplastin time with kaolin (PTT-K). These parameters and warfarin levels were measured before and following a single dose of warfarin given to five patients when hyperthyroid and again when euthyroid. Hyperthyroidism was associated with lower activity of factor II and a shorter PTT-K. Warfarin produced a greater fall in factors II and VII and a greater increase in PTR and PTT-K in the hyperthyroid state than in the euthyroid state. The enhanced response to warfarin in hyperthyroidism was, however, relatively greater for the PTR than for the PTT-K. In order to produce adequate protection against intravascular thrombosis by a suitable prolongation of the PTT-K, it may be necessary in hyperthyroid patients to extend the PTR beyond the normal therapeutic range.

MeSH terms

  • Aged
  • Blood Coagulation / drug effects*
  • Factor VII / metabolism
  • Female
  • Humans
  • Hyperthyroidism / blood*
  • Middle Aged
  • Partial Thromboplastin Time
  • Prothrombin / metabolism
  • Prothrombin Time
  • Warfarin / adverse effects*

Substances

  • Warfarin
  • Factor VII
  • Prothrombin