Key result
Warfarin therapy carries a ~4% annual rate of gastrointestinal bleeding in Taiwanese patients.
Why the study?
What is the incidence and what are the risk factors for gastrointestinal bleeding in Taiwanese patients treated with warfarin?
Cohort (n=401)
No
What is the incidence and what are the risk factors for gastrointestinal bleeding in Taiwanese patients treated with warfarin?
Warfarin confers a significant risk of gastrointestinal bleeding in Asian populations, necessitating strict INR monitoring, particularly in the elderly and patients with cirrhosis or a history of prior bleeding.
May support risk-stratified INR monitoring in Asian warfarin users; extends observational GIB data but leaves open need for prospective validation.
BACKGROUND: Warfarin reduces the incidence of thromboembolism but increases the risk of gastrointestinal bleeding (GIB). GIB during warfarin anticoagulation is rarely evaluated in Asian patients. AIMS: This study aimed at investigating the incidence, risk factors, management, and outcome of GIB in Taiwanese patients treated with warfarin. METHODS: We analyzed a cohort of warfarin anticoagulated patients between July 1993 and May 2012. Clinical data were retrieved in a chart-reviewing manner. RESULTS: A total of 401 warfarin anticoagulated patients were enrolled. The incidence of GIB was 3.9% per patient-years. Multivariate analysis with Cox regression showed that age >65 years old (RR: 2.5, 95% CI: 1.2-5.5), a mean international normalized ratio >2.1 (RR: 2.1, 95% CI: 1.0-4.2), a history of GIB (RR: 5.1, 95% CI: 1.9-13.5), and cirrhosis (RR: 6.9, 95% CI: 2.0-24.5) were independent factors predicting GIB. 27.3% of the GIB patients had rebleeding after restarting warfarin while thromboembolic events were found in 16.7% of the patients discontinuing warfarin therapy. CONCLUSIONS: Warfarin was associated with a significant incidence of GIB in Taiwanese patients. The intensity of anticoagulation should be monitored closely during warfarin therapy, especially in patients with risk factors of GIB.
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Chen et al. (2014) conducted a cohort in Warfarin Anticoagulation (n=401). Warfarin anticoagulation was evaluated on Incidence of gastrointestinal bleeding (per patient-years). The incidence of gastrointestinal bleeding was 3.9% per patient-year among Taiwanese patients treated with warfarin, with age >65, mean INR >2.1, prior GIB, and cirrhosis identified as independent risk factors.
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