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An analysis of bleeding complications related to warfarin in the emergency department

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Author(s): Pınar ÜNVERİR | Tuba DAĞ | Hülya PEYNİRCİ | Emine DEMİR | Cana CANBAY | Ahmet KAYA | Sedat YANTURALI

Journal: Turkish Journal of Emergency Medicine
ISSN 1304-7361

Volume: 6;
Issue: 3;
Start page: 117;
Date: 2006;

Keywords: Coumadine | hemorrhage | overdose | vitamin K | warfarin.

ABSTRACT
Objectives: Bleeding is the most frequent complication of the anticoagulant agents. Although bleeding complications are well-documented in the literature, our country data have been rarely reported. Description of demographic and clinical characteristics in the patients with bleeding related to the warfarin is purposed in our study on the emergency department. Materials and Methods: This study was a retrospective chart review of adult patients who were admittance to ED and those with have ordered International Normalized Ratio (INR) profile between December 2005 and May 2006. Warfarin overdose was defined as the INR ratio >4. Patients with hemorrhage related to warfarin overdose was defined as the first group and patients with hemorrhage without warfarin overdose was defined as the second group in patients with warfarin treatment. Clinical findings, hospitalization and discharging features were analyzed by using SPSS software. Results: Warfarin overdose was determined in 28 (33.6%) patients in total 120 patients on warfarin treatment. There were 14 (11.6%) patients in the first group and 22 (18.3%) patients in the second group. Coronary artery disease was the most common comorbid condition and atrial fibrillation was the most frequent anticoagulant indication in both groups. It was determined that gastrointestinal bleeding and intracranial hemorrhage are the most common hemorrhage complications in the first group and hematuria is the most common complication in the second group. Vitamin K treatment was administered 28.6% of all patients with warfarin overdose, 50% of patients with first group, and 4.5% of the second group. Majority of patients of both groups were discharged from the emergency department. Only two mortality (1.6%) were determined due to warfarin overdose. Conclusion: Frequency both of hemorrhage and administration of vitamin K in our hospital are higher than the literature.
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