Key result
Decreased food intake, recent illness, and other clinical factors predict warfarin bleeding, unlike HAS-BLED.
Why the study?
Warfarin remains widely used in resource-poor settings where bleeding from overdosage is common, and risk factors appear to vary across patient populations.
What are the clinical predictors of warfarin-associated bleeding in adult patients?
Case-Control
What are the clinical predictors of warfarin-associated bleeding in adult patients?
Answers are grounded in this paper and cite their sources.
Recent decrease in food intake, acute illness, older age, higher warfarin doses, and prior bleeding are independent predictors of warfarin-associated bleeding, highlighting the need for closer INR monitoring in these scenarios.
Despite the advent of directly acting oral anticoagulants, warfarin is still widely used in resource-poor settings. Bleeding as a result of warfarin overdosage is common and risk factors seem to vary between patient populations. Predictors of bleeding in patients using warfarin were studied using a case-control design. We calculated the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol (HAS-BLED) score (a bleeding risk prediction tool). Cases chosen were adults prescribed warfarin presenting with bleeding and controls were likewise taking warfarin but had no bleeding in the previous six months. The most common indication for warfarin use was venous thromboembolism. Recent decrease in food intake was strongly associated with bleeding. Older age, higher warfarin doses, recent illness in the past fortnight and prior bleeding were also independent predictors. A higher HAS-BLED score was not predictive independently. Closer monitoring of international normalised ratio is therefore advisable during acute illnesses and in those with decreased food intake.
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Hussain et al. (2024) conducted a case-control in Warfarin-associated bleeding. Warfarin vs. Warfarin without bleeding was evaluated on Predictors of bleeding. Recent decrease in food intake, older age, higher warfarin doses, recent illness, and prior bleeding were independent predictors of warfarin-associated bleeding, while HAS-BLED score was not.
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