June 12, 2000Archives of Internal Medicine
Prospective Study of the Outcomes of Ambulatory Patients With Excessive Warfarin Anticoagulation
Key result
Outpatients with an INR greater than 6.0 faced a significantly higher 14-day risk of major hemorrhage compared to those with an in-range INR (4.4% vs 0%; P<0.001).
Why the study?
Does excessive warfarin anticoagulation (INR > 6.0) increase the risk of major hemorrhage compared to target INR in outpatients?
Population
382 outpatients taking warfarin for longer than 1 month with an INR target range of 2.0 to 3.0, with no…
Comparison
Excessive warfarin anticoagulation managed with… vs Warfarin therapy with INR in the target range
Design
Cohort
Follow-up
14-day
Authors
Discussion
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Implication
INR >6.0 associated with higher short-term major hemorrhage risk; supports closer monitoring yet leaves optimal management open.
Study Design
Type
Cohort (n=382)
Structured PICO
Does excessive warfarin anticoagulation (INR > 6.0) increase the risk of major hemorrhage compared to target INR in outpatients?
P
Population
382 outpatients taking warfarin for longer than 1 month with an INR target range of 2.0 to 3.0, with no clinically apparent bleeding at the time of INR measurement.
I
Intervention
Excessive warfarin anticoagulation (INR > 6.0) managed with temporary discontinuation of warfarin therapy without phytonadione
C
Comparator
Warfarin therapy with INR in the target range (2.0 to 3.0)
O
Outcome
Major hemorrhage (defined as fatal, intracranial, or requiring hospitalization and transfusion of at least 2 U of blood) at 14-day follow-upsafety
Main Result
Absolute Event Rate: 4.4% vs 0%
p-value: p=<.001
Outpatients with an INR > 6.0 have a significantly increased short-term risk of major hemorrhage compared to those with an in-range INR, highlighting the need for careful management.
Cite This Study
Hylek et al. (2000) conducted a cohort in Excessive warfarin anticoagulation (n=382). INR greater than 6.0 vs. INR in target range (2.0 to 3.0) was evaluated on Major hemorrhage during 14-day follow-up (p=<.001). Outpatients with an INR greater than 6.0 faced a significantly higher 14-day risk of major hemorrhage compared to those with an in-range INR (4.4% vs 0%; P<0.001).