Abstract
Background. Warfarin is a commonly used oral anticoagulant agent. The most common adverse effects of warfarin are bleeding complications. Methods. We performed a 1-year retrospective chart review of emergency department patients using warfarin. A total of 65 patients with bleeding disorder (study group) and 63 patients without bleeding (control group) were included, making up a total of 128 subjects. Demographic data, frequency of international normalized ratio (INR) checks, and routine blood results were extracted. Logistic regression analysis was used to determine which factors were most closely associated with bleeding complications. Results. Median age was 62.0 ± 14.4 and 61.9 ± 14.5 for study group and control group, respectively. Educational status and frequency of INR checks were similar in both groups (P = 0.101 and P = 0.483, resp.). INR levels were higher in the study group (5.45 ± 3.98 versus 2.63 ± 1.71, P < 0.001). Creatinine levels were also higher in the study group (1.14 ± 0.57 mg/dL versus 0.94 ± 0.38 mg/dL, P = 0.042). Acetylsalicylic acid use was more frequent in the study group and was associated with a 9-fold increase in bleeding complications (P < 0.001). Conclusions. High INR levels, high creatinine levels, and acetylsalicylic acid use were associated with bleeding complications in ED patients using warfarin.
Highlights
The oral anticoagulant agent warfarin is used for treatment and prophylaxis of various thromboembolic diseases such as deep vein thrombosis, pulmonary embolism, stroke, heart valve replacement, and atrial fibrillation [1]
Patients were divided into two groups: study group (SG) consisting of 65 patients on warfarin use who were admitted to our emergency service for major or minor bleeding episodes and control group (CG) consisting of 63 patients on warfarin treatment who were admitted to our emergency service for various reasons without bleeding
While differences in age and gender were not different between groups, acetylsalicylic acid use was much more common (61%) in the study group compared to the control group (14%, P < 0.001)
Summary
The oral anticoagulant agent warfarin is used for treatment and prophylaxis of various thromboembolic diseases such as deep vein thrombosis, pulmonary embolism, stroke, heart valve replacement, and atrial fibrillation [1]. Patient-related risk factors for bleeding while using warfarin include age, INR, creatinine level, genetic characteristics (VKORC1 and CYP2C9 mutations), duration of warfarin use, and concomitant acetylsalicylic acid use. Renal failure and concomitant use of warfarin and acetylsalicylic acid are risk factors for bleeding [7, 8]. INR levels were higher in the study group (5.45 ± 3.98 versus 2.63 ± 1.71, P < 0.001). Creatinine levels were higher in the study group (1.14 ± 0.57 mg/dL versus 0.94 ± 0.38 mg/dL, P = 0.042). Acetylsalicylic acid use was more frequent in the study group and was associated with a 9-fold increase in bleeding complications (P < 0.001). High INR levels, high creatinine levels, and acetylsalicylic acid use were associated with bleeding complications in ED patients using warfarin
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