Emergency Department Visits due to the Bleeding Complication of Warfarin

INTRODUCTION: Warfarin is an anticoagulant that is used in case of thromboembolism risk or events as a prophylactic or therapeutic agent. In this study, we investigated the emergency visits due to the bleeding complication of warfarin.
METHODS: The patients admitted to emergency department with bleeding and using warfarin were included this study in a three year period. Age, gender, liver and kidney function tests, the time period of the warfarin use and the frequency of the control visits were recoded.
RESULTS: The patients admitted to emergency department with bleeding and using warfarin were included this study in a three year period (n=243). The regular follow up of coagulation parameter was observed in 92 (42.8%) patients. One hundred six (43.6%) of the patients had had a bleeding complication before. The most frequently observed bleeding region was urinary system (n=87, 35.8%). The INR level was greater than five in 223 (91.8%) of the patients. Fresh frozen plasma was used 193 (75.3%); prothrombin complex concentration was used in 15 (6.2%) patients; conservative management was preferred in 45(18.5%) patients. Mortality rate was 22 (9.1%) and 97 (39.9%) of the patients were discharged from emergency department without hospitalization. Female gender, low hemoglobin level, abnormal liver and kidney tests, INR level over 10 and irregular INR follow up were associated with both mortality and major bleeding (respectively; p=0.750, p<0.001, p<0.001, p<0.001, p<0.001, p<0.001).
DISCUSSION AND CONCLUSION: The interaction with other medications or foods, bleeding complications, its requirement of regular follow up of coagulation parameters and dose adjustment make difficult its use. We should tell the patients the importance of following the INR level regularly, especially in patients with co-morbid diseases.