Bleeding Complications in Warfarin-Treated Patients Admitted to the Emergency Department

Abstract

BackgroundIncreased use of warfarin for the treatment and prophylaxis of many diseases has increased the frequency of adverse events. Emergency departments (EDs) are the first places where early interventions for bleeding and other complaints related to warfarin use are performed. This study assessed the characteristics of patients receiving warfarin and the risk factors for bleeding complication among those admitted to the ED.MethodsPatients admitted to the ED for any reason other than trauma during a 1-year period were retrospectively reviewed. The study population consisted of 96 patients who had received warfarin and had an international normalized ratio (INR) ≥ 3. Patient demographics and medical history were recorded.ResultsThe mean age of the patients (female, 52.1%) was 64.9 ± 14.5 years. Fatigue was the most common presenting complaint (61%). At least one major and/or minor bleeding event had occurred in 32 (33.3%) of the patients. Patients with (n = 32) and without (n = 64) bleeding complications did not significantly differ with respect to age, sex, reason for warfarin initiation, duration of warfarin use, concomitant diseases, and concurrent medications. There were also no significant differences in the distribution of patient admissions in terms of season at presentation, INR level, and weekly warfarin dose.ConclusionsWhile the parameters evaluated in this study did not significantly differ among warfarin-treated patients, they may nonetheless pose a risk of bleeding. Further large-scale and long-term studies that take into account biological variation are required to precisely identify the risk factors for bleeding.

Probe into the Molecular Mechanism of Ibuprofen Interaction with Warfarin Bound to Human Serum Albumin in Comparison to Ascorbic and Salicylic Acids: Allosteric Inhibition of Anticoagulant Release

“…One strategy to allow for HSA to release warfarin has been using other drugs that also have a high affinity for HSA. − These release-aided drugs are usually over-the-counter drugs that people can use along with their major medicines. Nevertheless, sometimes displacement of warfarin bound to HSA results in an increase in warfarin free concentration, which could then elevate the risk of bleeding . Consequently, the consumption of other drugs with warfarin should be considered as a crucial point, and the concentration of warfarin in the blood must be controlled.…”

Bleeding Incidence in Patients Administered with Warfarin at Secondary Hospitals in Yogyakarta Province

“…The study found the incidence of bleeding in four patients with an average age of 70.25±5.32 years. Hematuria becomes a clinical manifestation of major bleeding in warfarin users, which is also found in a retrospective cross-sectional study involving 96 patients (58.82%) (Ozturk et al, 2019). In addition to the elderly age, heart disease and hypertension are associated with an increased risk of bleeding in treatment with warfarin which is also found in these four patients (Shoeb & Fang, 2013).…”

New Uses of Platelet-Lymphocyte Ratio for Bleeding Risk Stratification in Patients with Nonvalvular Atrial Fibrillation: A Pilot Study

“…Monteiro et al found that the annual incidence of minor bleeding was 17.7% 24 . Oztürk et al reported that 33.3% of the patients had experienced minor and/or major bleeding at least once during 1year period, moreover bleeding complications detected in 38.9% of patients ≥ 65 years of age and in 26.2% of patients <65 years of age 25 . A recent study showed that the clinically relevant minor bleeds and severe bleeding events were found 66.7% in the warfarin treatment group during the two-year follow-up 26 .…”