Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access |
Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc |
Journal website http://www.thejh.org |
Original Article
Volume 2, Number 2, October 2013, pages 55-63
Experience Always Wins the Day: Measure of Warfarin Anticoagulation Efficiency in the Internal Medicine Clinic
Figures
Tables
Number of patients (n) | |
---|---|
APLS: Antiphospholipid syndrome; HIT: Heparin-induced thrombocytopenia; INR: International normalized ratio; LWMH: Low weight molecular heparine. | |
Less than 3 INR values | 25 |
Auricular fibrillation | 17 |
Superficial venous thrombosis | 11 |
Use of LWMH | 11 |
Lack of data | 10 |
Arterial embolic/thrombotic event/APLS | 7 |
Outside the study period | 5 |
Follow-up done by another service | 3 |
No anticoagulation | 3 |
Cerebrovascular event | 3 |
Retinal thrombosis | 3 |
Jugular venous thrombosis | 2 |
Portal vein thrombosis | 2 |
Digital ischemia | 1 |
Sagital sinus thrombosis | 1 |
Superior vena cava syndrome | 1 |
Mesenteric vein thrombosis | 1 |
Warfarin allergy | 1 |
HIT | 1 |
Surgical repair of patent foramen ovale | 1 |
Not present at follow-up | 1 |
Total n (%) | |
---|---|
All data are no. (%) of patients unless otherwise indicated; * Defined by a hemoglobin value < 120 for women and < 140 for men; ** Defined by an elevation any liver function test (LFT) at three times the upper normal limit. | |
Age mean (range) | 61 (21 - 97) |
Gender (male) | 112 (47) |
Weight mean in kg (range) | 82.7 (44.4 - 185) |
Excessive alcohol consumption | 8 (3.4) |
Chronic kidney disease - GFR < 60 mL/min | 28 (11.8) |
Hepathopathy* | 6 (2.5) |
Hypertension | 96 (40.5) |
Anemia** | 88 (37.1) |
Past medical history of bleeding | 12 (5.0) |
Concomitant use of antiplatelet drugs | 22 (9.3) |
Past history of stroke | 9 (3.8) |
Past history of DVT/PE | 90 (38) |
Active cancer | 24 (10.1) |
No of patients (n) | No of INR (n) | Median follow-up (days) | Median proportion of time at target INR 2.0 - 3.0 (%) | 95% CI | P-value | |
---|---|---|---|---|---|---|
All data are no. of patients unless otherwise indicated; * Defined by a Glomerular Function Rate (GFR) > 60 mL/min; ** Defined by a GFR < 60 mL/min; y.o: Years old. | ||||||
Overall | 237 | 2,553 | 250.5 | 68.9 | 63.1- 69.1 | NA |
Gender | ||||||
Women | 125 | 1423 | 229 | 65 | 47 -81 | |
Men | 112 | 1130 | 335 | 70 | 50 -86 | 0.153 |
Chronic kidney disease | ||||||
No* | 198 | 2,155 | 250.5 | 65 | 48 - 83 | |
Yes** | 28 | 398 | 356.5 | 80 | 72 - 90 | 0.048 |
Age | ||||||
< 40 y.o | 25 | 237 | 101 | 55 | 42 -83 | |
40 - 60 y.o | 111 | 1,198 | 249 | 66 | 48 -81 | |
> 60 y.o | 101 | 1,118 | 251 | 73 | 50 -87 | 0.186 |
Type of event | INR at complication | Intervention necessary | |
---|---|---|---|
AcO: Anticoagulation; ATB: Antibiotics; ENT: Ear-nose-throat; FFP: Fresh frozen plasma; GI: Gastrointestinal; HD: Hemodynamic; IVCF: Inferior vena cava filter; OGD: Oesophageal-gastro-duodenoscopy; PE: Pulmonary embolism; PRBC: Packed red blood cell; UK: unknown. | |||
Thrombotic event | |||
F87 | PE | 2.1 | None |
Minor haemorrhagic event | |||
F55 | Macroscopic hematuria | 2.9 | Cystoscopy/ureteroscopy/pyelography |
F57 | Epistaxis | UK | None |
M68 | Hematochezia (anal fissure) | 2.0 | None |
F49 | Iron-deficiency anemia (menorrhagia) | UK | Intravenous iron repletion |
F52 | ENT bleeding | 2.4 | ENT consultation |
F87 | Epistaxis | UK | None |
Major haemorrhagic event | |||
F59 | Lower GI bleeding | > 9 | Transfusion/colonoscopy/AcO termination |
F66 | Upper GI bleeding (H. pylori gastritis) | 4.1 | Transfusion (1PRBC)/OGD/ATB/AcO termination |
F79 | Knee hemarthrosis | 3.8 | Vitamin K/surgical drainage/AcO suspension |
M63 | Upper GI bleeding (gastric cancer) | 1.1 | OGD/AcO termination |
M66 | Lower GI bleeding | UK | OGD/colonoscopy/arteriography/IVCF/AcO termination |
F87 | Thigh hematoma with HD instability | 2.6 | Transfusion (3PRBC)/AcO termination |
M83 | Lower GI bleeding (angiodysplasia) | 2.7 | Transfusion (2PRBC)/AcO termination |
M64 | Lower GI bleeding (angiodysplasia) | 6.3 | Transfusion (2PRBC and 3FFP)/AcO termination |
F52 | Lower GI bleeding (haemorrhoid) | 1.4 | Vitamin K/colonoscopy/AcO suspension |
M77 | Post-traumatic leg hematoma | 4.1 | Vitamin K/AcO termination at the patient demand |