Analysis of situation of bleeding due to warfarin in anticoagulant clinic patients

Abstract

Objective To analyze the situation of bleeding in patients during oral warfarin treatment in an anticoagulant clinic. Methods The medical record data of patients who received warfarin treatment in Anticoagulant Clinic of Fuwai Hospital, Chinese Academy of Medical Sciences from May 1st, 2016 to April 30th, 2017 were collected from the hospital outpatient information system and analyzed retrospectively. According to age, the patients were divided into the youth group ( 65-year-old). According to indications of anticoagulation therapy, the patients were divided into the postoperative group of valve replacement (postoperative group), the atrial fibrillation/atrial flutter group, and the thromboembolic disease group. The situation of bleeding events during warfarin treatments in patients in the different age groups and the different indication groups were compared. Results A total of 915 patients were enrolled into the study, including 468 males and 447 females with ages from 14 to 89 years and an average age of (58±14) years. The youth group, the middle age group, and the older age group comprised 127, 482, and 306 patients, respectively. The postoperative group, the atrial fibrillation/atrial flutter group, and the thromboembolic disease group comprised 574, 271, and 70 patients, respectively. The number of patients whose warfarin dosage were ≤5 mg/d or 5-9 mg/d was 847 or 69, respectively. There were more patients with valve replacement in the youth and the middle age groups[87.40% (111/127), 73.86% (356/482)] and more patients with atrial fibrillation/ atrial flutter in the older age group[55.88% (171/306)]. Of the 915 patients, 87 developed bleeding events during warfarin treatment, which were evaluated to be induced by warfarin and the incidence of bleeding was 9.51%. Seven of the 87 patients were with severe bleeding and the incidence was 0.77%. The incidence of bleeding in the older age group was significantly higher than that in the middle age group[15.03% (46/306) vs. 7.05% (34/482), P 0.05). Of the 87 patients with bleeding, 75 (86.21%) were with single time bleeding, 71 (81.61%) were with single site bleeding, 80 (91.85%) were with slight bleeding; warfarin dosages in 82 (94.25%) patients were ≤5 mg/d, international normalized ratios (INR) in 77 (88.51%) patients were ≤3.00. Twelve (13.79%) patients received combined use of other drugs during warfarin treatment. A total of 113 times of bleeding events occurred in 87 patients, including 31 times of skin mucosal hemorrhage, 19 times of gingival bleeding, 13 times of hemorrhinia hemorrhage and ocular hemorrhage, 10 times of hemoptysis, 7 times of fecal occult blood and/or hemorrhoidal bleeding, 6 times of hemorrhage of digestive tract and urine occult blood, 5 times of gross hematuria, 1 time of menstrual extension, colporrhagia, and intracranial hemorrhage. Conclusions The incidence of bleeding in outpatients during warfarin treatment in Anticoagulant Clinic in Fuwai Hospital is 9.51%. The bleeding mainly occurred in elders and patients with auricular fibrillation or atrial flutter. The bleeding in most patients is mild. Key words: Warfarin; Hemorrhage; Outpatients