Bleeding Due to Warfarin Treatment: Five Years of Experience

ABS TRACT Objective: The aim of the study was to determine the factors contributing to the development of bleeding and mortality in patients admitted to emergency department with any nontraumatic bleeding (major or minor) complaint while under warfarin therapy. Material and Methods: Patients who admitted to the emergency department of a university hospital between 2009 and 2013 due to bleeding complications during warfarin treatment were included in the study which was conducted in a prospective and observational design. The demographic characteristics of the patients, the reasons for using warfarin, the types and localizations of the bleedings, the treatments applied, the duration of hospitalization and mortality data were recorded. The factors that are likely to be effective on bleeding and mortality (age, hemodynamic status on admission, initial INR levels, warfarin dose, etc.) were analyzed comparatively. SPSS version 16.0 program was used for statistical analysis and p<0.05 was considered statistically significant. Results: A total of 518 patients were enrolled in the study. The mean age of the patients was 64.19±13.28 years, 229 (44.2%) of the patients were male. More than half of the patients were over 65 years of age, the most common indication for warfarin was heart valve disease and atrial fibrillation, and the most mortal bleeding type was gastrointestinal bleeding. There was no correlation between the first INR levels on admission and the bleeding severity and mortality (p=0.577, p=0.788). The most significant indicator of mortality was hemodynamic instability during admission. Systolic and diastolic arterial blood pressure and haemoglobin levels were significantly lower (p=0.004, p=0.023, p=0.001, respectively) in nonsurvivors, whereas pulse and shock index were significantly higher (p<0.001, p<0.001). Conclusion: Patients under warfarin treatment admit to emergency services with major or minor bleeding independently from INR levels. Especially, patients aged 65 and over are at risk. The most significant indicator of mortality appears to be hemodynamic instability during admission.