Varfarin Kullanan Hastalarda Kanama ile İlişkili Faktörler

Year 2021, , 482 - 491, 31.12.2021

Mehmet Ekiz , Latif Duran , Hızır Ufuk Akdemir , İskender Aksoy

https://doi.org/10.24938/kutfd.943109

Abstract

Amaç: Pek çok farklı disiplin tarafından yaygın olarak reçete edilen ve oral bir antikoagülan olan varfarinin en ciddi yan etkisi kanamadır. Bu çalışmada, varfarin kullanımı sonucu ortaya çıkan kanama komplikasyonu üzerine etkili olan faktörler araştırılmıştır.

Gereç ve Yöntemler: Bu çalışmada, varfarin kullanan ve acil servise kanama şikâyeti ile başvuran 111 hasta incelendi. Tüm hastalar başvuru anındaki “international normalized ratio” değerine göre Grup I (international normalized ratio >3.5) ve Grup II (international normalized ratio ≤3.5) olmak üzere iki gruba ayrıldı. Gruplar demografik özellikler, başvuru şikâyeti, varfarin kullanma endikasyonu, eşlik eden hastalıklar, kullanılan diğer ilaçlar, varfarin kullanma süresi, international normalized ratio değeri, kanama lokalizasyonu, tedavi ve girişimler bakımından karşılaştırıldı.

Bulgular: Yüz on bir hastanın 85'i Grup I’de ve 26’sı da Grup II’de yer almaktaydı. Hastaların 56’sı (%50.5) kadındı. Çalışmamızda, varfarin kullanımının en yaygın nedeni kalp kapak replasmanı idi (%46.8). En sık başvuru şikâyeti kanlı dışkılama (%41.5) idi. Çalışmamızda hastaların 79'unda eşlik eden en az bir hastalık vardı. Hastalarımızın en sık görülen komorbid hastalığı hipertansiyon (n=50, %45) idi. Yetmiş altı hastada majör kanama olduğu ve majör kanamanın Grup I'de daha yüksek olduğu tespit edildi.

Sonuç: Uluslararası normalize oran değeri>3.5 olan hastalarda major kanamanın ve hastaneye yatış ihtiyacının daha fazla olduğu, acil serviste takip süresinin daha uzun olduğu tespit edilmiştir. Uluslararası normalize oran değeri, warfarine bağlı kanama için önemli bir faktör olmasına rağmen, kanamadan sorumlu tek neden uluslararası normalize oran değeri değildir ve kanamadan ek faktörler sorumlu olabilir.

Keywords

varfarin, kanama, acil, uluslararası standardize oran

THE FACTORS ASSOCIATED WITH BLEEDING IN PATIENTS USING WARFARIN

Abstract

Objective: The most serious side effect of warfarin, an oral anticoagulant widely prescribed by many different disciplines, is bleeding. In this study, the factors affecting the bleeding complications resulting from the use of warfarin were investigated.

Material and Methods: In this study, 111 patients using warfarin and admitted to the emergency department with bleeding complaints were evaluated. All patients were divided into two groups as Group I (international normalized ratio >3.5) and Group II (international normalized ratio ≤3.5) according to the "international normalized ratio" value at the time of admission. The groups were compared in terms of demographic characteristics, admission complaint, indications for warfarin use, concomitant diseases, other drugs used, duration of warfarin use, international normalized ratio value, bleeding localization, treatment and interventions.

Results: Of the 115 patients, 85 were in Group I and 26 were in Group II. Fifty-six (50.5%) of the patients were women. In our study, the most common reason for warfarin use was heart valve replacement (46.8%). The most common complaint was bloody stool (41.5%). Of the patients, 79 of had at least one concomitant disease. The most common comorbid disease of our patients was hypertension (n=50, 45%). Seventy-six patients were found to have major bleeding and major bleeding was higher in Group I.

Conclusion: It was determined that major bleeding and need for hospitalization were higher in patients with an international normalized ratio value >3.5, and the follow-up period in the emergency department was longer. Although the international normalized ratio value is an important factor for warfarin-induced bleeding, the international normalized ratio value is not the only cause of bleeding and additional factors may be responsible for bleeding.

Keywords

warfarin, ınternational normalised ratio, hemorrage, emergency

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