Hypercoagulable state and thromboembolism following warfarin withdrawal in post-myocardial-infarction patients

Eur Heart J. 1991 Nov;12(11):1225-33. doi: 10.1093/eurheartj/12.11.1225.


Nine out of 47 (19%) patients on chronic anticoagulation with warfarin, as secondary prophylaxis after myocardial infarction, initially treated with streptokinase, had thromboembolic complications within 4 weeks after sudden (7/25) or gradual (2/22:NS) warfarin withdrawal. The biochemical effects of warfarin withdrawal were repeatedly studied in 20 of the patients during the first 14 days following drug cessation. During the first 4 days, the levels of coagulation factors VII and IX increased more rapidly than proteins C and S. Thus, a gap was created between the factors provoking and inhibiting the coagulation process. Furthermore, plasma concentrations of fibrinopeptide A (FPA) increased, reflecting activation of the coagulation system. These laboratory findings suggest that withdrawal of warfarin creates a transient hypercoagulable state, imposing a risk of thromboembolic events in patients given anticoagulant treatment as secondary prophylaxis following myocardial infarction.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Angina, Unstable / blood
  • Angina, Unstable / etiology
  • Blood Coagulation Disorders / blood
  • Blood Coagulation Disorders / etiology*
  • Blood Coagulation Factors / analysis
  • Cerebrovascular Disorders / blood
  • Cerebrovascular Disorders / etiology
  • Drug Therapy, Combination
  • Female
  • Heparin / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / drug therapy*
  • Peripheral Vascular Diseases / blood
  • Peripheral Vascular Diseases / etiology
  • Streptokinase / therapeutic use
  • Thromboembolism / blood
  • Thromboembolism / etiology*
  • Thromboembolism / prevention & control
  • Treatment Outcome
  • Vitamin K
  • Warfarin / therapeutic use*


  • Blood Coagulation Factors
  • Vitamin K
  • Warfarin
  • Heparin
  • Streptokinase