Key result
Among 111 patients presenting to the emergency department with warfarin-induced bleeding, 76 experienced major bleeding, with no statistically significant difference in bleeding severity between those with an INR >3.5 and those with an INR ≤3.5 (p>0.05).
Why the study?
Bleeding is the most serious side effect of warfarin, prompting an investigation into factors affecting bleeding complications resulting from its use.
Does a supratherapeutic INR (>3.5) compared to an INR ≤3.5 increase the severity of bleeding and need for hospitalization in patients on warfarin presenting to the emergency department?
Observational (n=111)
No
Does a supratherapeutic INR (>3.5) compared to an INR ≤3.5 increase the severity of bleeding and need for hospitalization in patients on warfarin presenting to the emergency department?
p-value: p=>0.05
In patients presenting to the emergency department with warfarin-induced bleeding, an INR >3.5 is associated with higher rates of major bleeding and hospitalization, though bleeding severity is also influenced by other factors such as interacting medications and comorbidities.
May not support INR >3.5 for stratifying bleeding severity in warfarin users; leaves open need for prospective validation.
Objective: The most serious side effect of warfarin, an oral anticoagulant widely prescribed by many different disciplines, is bleeding. In this study, the factors affecting the bleeding complications resulting from the use of warfarin were investigated.Material and Methods: In this study, 111 patients using warfarin and admitted to the emergency department with bleeding complaints were evaluated. All patients were divided into two groups as Group I (international normalized ratio >3.5) and Group II (international normalized ratio ≤3.5) according to the "international normalized ratio" value at the time of admission. The groups were compared in terms of demographic characteristics, admission complaint, indications for warfarin use, concomitant diseases, other drugs used, duration of warfarin use, international normalized ratio value, bleeding localization, treatment and interventions.Results: Of the 115 patients, 85 were in Group I and 26 were in Group II. Fifty-six (50.5%) of the patients were women. In our study, the most common reason for warfarin use was heart valve replacement (46.8%). The most common complaint was bloody stool (41.5%). Of the patients, 79 of had at least one concomitant disease. The most common comorbid disease of our patients was hypertension (n=50, 45%). Seventy-six patients were found to have major bleeding and major bleeding was higher in Group I.Conclusion: It was determined that major bleeding and need for hospitalization were higher in patients with an international normalized ratio value >3.5, and the follow-up period in the emergency department was longer. Although the international normalized ratio value is an important factor for warfarin-induced bleeding, the international normalized ratio value is not the only cause of bleeding and additional factors may be responsible for bleeding.
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Ekiz et al. (2021) conducted an observational in Warfarin-induced bleeding (n=111). Supratherapeutic INR (>3.5) vs. INR ≤3.5 was evaluated on Severity of bleeding (major vs minor) (p=>0.05). Among 111 patients presenting to the emergency department with warfarin-induced bleeding, 76 experienced major bleeding, with no statistically significant difference in bleeding severity between those with an INR >3.5 and those with an INR ≤3.5 (p>0.05).
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