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The Analysis of Cases Admitted to Intensive Care Units from Emergency Department Due to Complications Related to Warfarin Treatment

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Author(s): Murat EROGLU | Orhan CINAR | Erdem CEVIK | Levent YAMANEL | Murat DURUSU | Volkan INAL | Bilgin COMERT

Journal: Turkish Journal of Emergency Medicine
ISSN 1304-7361

Volume: 11;
Issue: 1;
Start page: 9;
Date: 2011;
Original page

Keywords: Anticoagulation | bleeding | warfarin | intensive care.

ABSTRACT
Objectives: Most of cases that present to the emergency departments (EDs) due to complications related to warfarin therapy are successfully treated in the ED, except only for a small group for which admission to the intensive care units (ICUs) is required. In our study, we aimed to introduce the demographic and clinical characteristics of this group needed to ICU admission. Methods: The records of 30 patients who presented to the Gulhane Military Medical Academy ED (Ankara, Turkey) and required admission to ICU due to the complications related to warfarin therapy were retrospectively reviewed. Patients were evaluated according to age, sex, bleeding region, comorbid diseases, INR (International Normalized Ratio) levels, treatments and outcomes. Results: Average age of patients were 66.9±12 and 57% of the patients were female. Eighty percent of the patients (n=24) had 2 or more comorbid disease. Average INR level have been determined as 9.46. INR levels were under 5 in 11 patients (16.6%), between 5-9 in 15 patients (36.6%) and between 9-18 in 14 patients (46.6%). The most common observed bleeding region was in gastrointestinal system with 13 patients (43%) followed by genitourinary system with 8 patients (26%). Intravenous vitamin K therapy in 25 patients (83%), FFP (fresh frozen plasma) therapy in 23 patients (76%) and erythrocyte suspension therapy in 13 patients (43%) have been provided. Mortality was observed in two patients (6.6%) and these patients’ INR levels were 7.92 and 7.15, respectively. The gastrointestinal and genitourinary systems are most frequently seen bleeding sites. Vitamin K and FFP application were required for significant proportion of the patients who are admitted to ICU. No significant relationship between INR levels and mortality has been observed. Conclusions: As a result, besides bleeding, old age, presence of comorbid disease and high INR levels seems to be important factors in the decision of admission to ICU.
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