Display options
Share it on

J Clin Med Res. 2019 Feb;11(2):106-113. doi: 10.14740/jocmr3669. Epub 2019 Jan 05.

Bleeding Complications in Warfarin-Treated Patients Admitted to the Emergency Department.

Journal of clinical medicine research

Mustafa Ozturk, Afsin Ipekci, Sevil Kusku Kiyak, Yonca Sinem Akdeniz, Yavuz Aydin, Ibrahim Ikizceli, Ozgur Sogut

Affiliations

  1. Department of Emergency Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey.
  2. Department of Emergency Medicine, University of Istanbul Cerrahpasa, Istanbul, Turkey.

PMID: 30701002 PMCID: PMC6340679 DOI: 10.14740/jocmr3669

Abstract

BACKGROUND: Increased use of warfarin for the treatment and prophylaxis of many diseases has increased the frequency of adverse events. Emergency departments (EDs) are the first places where early interventions for bleeding and other complaints related to warfarin use are performed. This study assessed the characteristics of patients receiving warfarin and the risk factors for bleeding complication among those admitted to the ED.

METHODS: Patients admitted to the ED for any reason other than trauma during a 1-year period were retrospectively reviewed. The study population consisted of 96 patients who had received warfarin and had an international normalized ratio (INR) ≥ 3. Patient demographics and medical history were recorded.

RESULTS: The mean age of the patients (female, 52.1%) was 64.9 ± 14.5 years. Fatigue was the most common presenting complaint (61%). At least one major and/or minor bleeding event had occurred in 32 (33.3%) of the patients. Patients with (n = 32) and without (n = 64) bleeding complications did not significantly differ with respect to age, sex, reason for warfarin initiation, duration of warfarin use, concomitant diseases, and concurrent medications. There were also no significant differences in the distribution of patient admissions in terms of season at presentation, INR level, and weekly warfarin dose.

CONCLUSIONS: While the parameters evaluated in this study did not significantly differ among warfarin-treated patients, they may nonetheless pose a risk of bleeding. Further large-scale and long-term studies that take into account biological variation are required to precisely identify the risk factors for bleeding.

Keywords: Emergency department; International normalized ratio; Major bleeding event; Minor bleeding event; Warfarin-treated patients

References

  1. Lancet. 1999 Feb 27;353(9154):717-9 - PubMed
  2. Chest. 2001 Jan;119(1 Suppl):8S-21S - PubMed
  3. J Am Coll Cardiol. 2003 May 7;41(9):1633-52 - PubMed
  4. Pathophysiol Haemost Thromb. 2002 Jul-Aug;32(4):151-4 - PubMed
  5. Chest. 2006 Nov;130(5):1390-6 - PubMed
  6. Neurology. 2007 Jan 9;68(2):116-21 - PubMed
  7. J Manag Care Pharm. 2006 Oct;12(8):640-8 - PubMed
  8. J Thromb Thrombolysis. 2008 Apr;25(2):151-9 - PubMed
  9. Thromb Haemost. 2009 Sep;102(3):588-92 - PubMed
  10. Mayo Clin Proc. 2009 Dec;84(12):1079-94 - PubMed
  11. Am Fam Physician. 2010 Mar 15;81(6):780 - PubMed
  12. Aust Fam Physician. 2010 Jul;39(7):476-9 - PubMed
  13. Lancet. 2010 Sep 18;376(9745):975-83 - PubMed
  14. Semin Neurol. 2010 Nov;30(5):565-72 - PubMed
  15. Ann Emerg Med. 2011 Aug;58(2):192-9 - PubMed
  16. Ann Hematol. 2011 Oct;90(10):1191-200 - PubMed
  17. Ann Pharmacother. 2011 Jul;45(7-8):881-7 - PubMed
  18. PLoS One. 2015 Dec 16;10(12):e0144511 - PubMed
  19. Am J Med. 1989 Aug;87(2):153-9 - PubMed
  20. Am J Med. 1989 Aug;87(2):144-52 - PubMed
  21. JAMA. 2016 Nov 22;316(20):2115-2125 - PubMed
  22. Ann Intern Med. 1994 Nov 1;121(9):676-83 - PubMed
  23. Lancet. 1996 Aug 17;348(9025):423-8 - PubMed
  24. Br J Clin Pharmacol. 1977 Jun;4(3):315-20 - PubMed
  25. J Gen Intern Med. 1998 May;13(5):311-6 - PubMed

Publication Types