Management of warfarin complications in the emergency department

Abstract

INTRODUCTION: Bleeding is the risk related to long-term warfarin therapy and rises significantly at INR values above 4.5. The goal of warfarin reversal is to elevate vitamin K-dependent clotting factors. The aim of this study was to evaluate the management of the warfarin related bleeding complications in acute care patients. METHODS: A totally of 74 patients with on warfarin treatment, who admitted to our acute care clinic were enrolled to the study. The patients were grouped into three groups based on International normalized ratio (INR) levels. INR levels of the groups were <3.0 for Group-I, 3.0≤INR ≤5.0 for Group-II and INR>5.0 for Group-III. Patients' medical history, medications and warfarin related complications were recorded throughout examination. RESULTS: In hematological analysis, platelet count and mean platelet volume were similar between groups. Plateletcrit and hemoglobin levels were significantly higher in group-I than group-III (p=0.01). There was no significance difference between groups in blood group analysis. Group-I and group-II were evaluated without medical intervention yet fresh frozen plasma (FFP) and erythrocyte suspension (ES) were given significantly in group-III. Patients in group-I and group-II were discharged usually, and group-III subjects were followed-up in the hospital. DISCUSSION AND CONCLUSION: This study demonstrated that warfarin anticoagulation at higher INR levels and without bleeding complication was managed by conservatively. Intravenous vitamin K was administered at minor bleeding complications in patients with warfarin anticoagulation. FFP and vitamin K was administered at the high INR levels with major bleeding complications in patients with warfarin anticoagulation.

Keywords

• warfarin
• bleeding
• anticoagulation
• vitamin k.