Clinical Study

Determining Risk Factors of Bleeding in

Patients on Warfarin Treatment
Evren Uygungül, Cuneyt Ayrik, Huseyin Narci, Semra ErdoLan,
Ebrahim Toker, Filiz Demir, and Ulas Karaaslan

Hindawi Publishing Corporation

Advances in Hematology
Volume 2014, Article ID 369084, 5 pages

dr. Vina Tri Aditya*

dr. Shinta Oktya Wardhani SpPD**

*Resident of Internal Medicine Department, dr. Saiful Anwar General Hospital, Brawijaya University Faculty of Medicine
**Supervisor in Hematology Oncology Department, dr. Saiful Anwar General Hospital, Brawijaya University Faculty of
Medicine
 aimedaimed
to determine
to determine
the risk
the risk
factors
factors
for bleeding
for bleeding
in our
in our
emergency
emergencydepartment
department (ED)(ED)
in pati
in pati
entsents
taking
taking
warfarin
warfarin
Introduction

Warfarin

bleeding complications
bleeding
most
most common adverse
effects ofcomplications
effectscommon
anticoagulant
anticoagulant agent
agent

of warfarin
oraloral

warfarin are
a commonly
a commonly usedused

adverse
are
 Materials and Methods

1 year retrospective charts

1 .Stu d yG ro u p (SG ):

Ex trac t de mographic and cl inic al da ta 2 .C o

6 5 p ati en ts
n tro led gro u p (C G ):6 3 p ati en ts

age, gender, educational status, INR, hemoglobin, platelet count, AST, ALT, creatinine, and
INR control intervals CRP levels fo rp u
sen to o u ED
Exclu d ed :
r fro m an o th erh ealth carefilty
rp o seo fvitam in K ,p lasm a,o rb lo o d ad m in istrati o n
 Statistical Methods

n SPSS
Shapiro-
udent’s
ney version
-test
Wilk test
st 11.5
 Result
Table 1 Comparisons between the two groups (SG and CG)
 Result
Table 1 Comparisons between the two groups (SG and CG)
Result

INR

Logistic
regression
analysis
Result
 Discussion
Patients with bleeding-related ED visits, 83% of our SG
patients had primary school level education or less

●
giving more education about warfarin’s risks and arranging
closer followup of patients with little education

the risk was lower in younger patients, especially

those who had stable INR levels over the long term

●
extending the duration between INR checks from every 3-4
weeks to 8–12 weeks
 Discussion
age is an important risk factor for bleeding in
patients using warfarin

●
warfarin is reasonably safe to use in elderly atrial fibrillation
patients if they are carefully monitored

The VKORC1 and CYP2C9 gene mutations are

associated with higher bleeding risk in patients on
warfarin

●
dosages should be modified when these mutations are found
 Discussion

Moderate to severe renal failure on warfarin have

higher INR levels and risk of bleeding compared to
those with normal kidney function

Acetylsalicylic acid is probably the most problematic

agent, as it is commonly used and its platelet-
inhibiting properties act synergistically
 Discussion

Coagulation pathways were triggered in cases of

severe infections; therefore, one might expect an
increased bleeding risk in patients using warfarin
who have severe infections

●
Higher CRP levels in our SG patients than in our CG
patients
Limitations
 Conclusion
Patients using warfarin,
increased INR level, high
creatinine, and
concomitant use of
acetylsalicylic acid are
strongly associated with a
bleeding-related visit

Studies of genetic
variations among
emergency department
patients using warfarin
who have bleeding-
related complaints should
be performed
Thanks