A study of elderly adults taking warfarin admitted with prolonged international normalized ratio: a community hospital's experience.

Abstract

OBJECTIVES:

To assess bleeding complications and outcome of individuals receiving oral anticoagulants who were admitted to the hospital with an international normalized ratio (INR) greater than 4 by comparing them according to age (≤ 80, >80).

DESIGN:

Retrospective cohort study.

SETTING:

Community hospital.

PARTICIPANTS:

All individuals (N = 253) admitted to the Department of Internal Medicine over a period of 4 years with an INR greater than 4: Group I, aged 80 and younger (n = 127); Group II, older than 80 (n = 126). Data included bleeding complications, survival, and quality of INR control before admission and up to 48 months after admission.

RESULTS:

Atrial fibrillation was the most common indication for warfarin therapy. Its incidence was higher in the older group (88% vs 73%, P = .004). More elderly participants lived in nursing homes (23% vs 9.4%. P = .004) or received in-home assistance (38.9% vs 20.5%, P = .002). There was no difference in INR upon admission, duration of warfarin treatment, or frequency of INR tests before admission. The incidence of bleeding events was 18.1% in Group I and 12.7% in Group II (P = .30). Major bleeding events occurred in 1.6% of Group I and none of Group II (P = .50). During follow-up after the first admission, the incidence of INR greater than 4 was higher in Group II (87.3% vs 70%, P = .02), without a difference in the number of additional admissions or bleeding events.

CONCLUSION:

Primary care physicians can safely maintain warfarin treatment in elderly adults, even in those with a history of hospitalization for high INR, using frequent INR measurements.

• Authors: Michael Bergman, Yaacov Ori, Naava Blumberger, Zachary Z Brener, Hertzel Salman
• Journal: Journal of the American Geriatrics Society (J Am Geriatr Soc) Vol. 60 Issue 9 Pg. 1713-7 (Sep 2012) ISSN: 1532-5415 [Electronic] United States
• PMID: 22880717 (Publication Type: Journal Article)
• Copyright: © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Chemical References

• Anticoagulants
• Warfarin

Topics

• Adult
• Aged
• Aged, 80 and over
• Anticoagulants (administration & dosage)
• Chi-Square Distribution
• Female
• Hospitals, Community
• Humans
• International Normalized Ratio
• Male
• Middle Aged
• Retrospective Studies
• Warfarin (administration & dosage)