Assessment of factors affecting mortality in geriatric patients with warfarin overdose

Abstract

OBJECTIVES: The aim of the present study was to perform a demographic analysis of complications and to determine the factors affecting in-hospital mortality in geriatric patients with warfarin overdose. MATERIALS AND METHODS: All patients aged 65 years or older using warfarin with an international normalized ratio (INR) level above 3.5 IU between 01.01.2014 and 01.01.2018 were included in the study. Characteristics of patients with in-hospital mortality and surviving patients were compared. Multivariate regression analysis was used to assess the predictors for in-hospital mortality. RESULTS: A total of 302 geriatric patients included in the study for statistical analyses. Bleeding rate was 14.2%. A comparison of patient characteristics for in-hospital mortality (survivor vs. nonsurvivor) revealed significant differences for age, gender, chronic renal failure history, creatinine, aspartate aminotransferase (AST), and alanine aminotransferase levels ( P < 0.05). A multivariate logistic regression analysis was performed. It was found that elevated AST ( P = 0.029, odds ratio [OR]: 1.004, 95% confidence intervals [CIs]; 1.001–1.007) and creatinine ( P = 0.045, OR: 2.36, 95% CIs; 1.02–5.48) levels as well as advanced age ( P = 0.031, OR: 1.11, 95% CIs; 1.01–1.22) and male gender ( P = 0.017, OR: 5.48, 95% CIs; 1.35–22.1) had a negative impact on survival. CONCLUSION: Our study results revealed that male gender, advanced age, and hepatic and renal dysfunctions were the predictors of in-hospital mortality in the elderly with warfarin overdose. In order to avoid serious warfarin-related complications in the older age groups, particularly when there is renal or hepatic dysfunction, patients should be informed about minor warning side effects of warfarin, INR levels should be more frequently checked, and patients should have more strict follow-up schedules.

Spontaneous triceps hematoma and radial nerve impairment due to warfarin use

“…Intracranial hemorrhage, gastrointestinal bleeding, compartment syndrome due to intramuscular hemorrhage are serious bleeding complications. There are studies in the literature showing that these complications occur more frequently in the elderly without trauma (5). Our patient also had a spontaneously developing intramuscular hematoma.…”

Predictors of 30-day mortality in patients with an international normalized ratio of 4.5 - 10 due to warfarin-related overanticoagulation: a retrospective cohort study

“…The literature have demonstrated a significant increase in complications, including bleeding risk, in patients with elevated INR compared to those within acceptable INR levels [4][5] . Although the administration of vitamin K in patients with elevated INR has been shown to effectively lower the INR level to the desired range in various studies, its positive impact on bleeding and mortality remains contradictory in patients with INR between 4.5 and 10 1,6,7 .…”