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.
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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)
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Copyright | © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society. |
Chemical References |
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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)
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