Varfarin Kullanan Hastalarda Kanama ile İlişkili Faktörler

Year 2021, Volume: 23 Issue: 3, 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

References

• 1. Visser LE, Bleumink GS, Trienekens PH, Vulto AG, Hofman A, Stricker BHC. The risk of over anticoagulation in patients with heart failure on coumarin anticoagulants. Br J Haematol. 2004;127(1):85-9.
• 2. Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2008;133(6):160S-98S.
• 3. Hirsh J, Guyatt G, Albers GW, Harrington R, Schünemann HJ. Antithrombotic and thrombolytic therapy: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2008;133(6):110S-2S.
• 4. Makris M, Watson H. The management of coumarin‐induced over‐anticoagulation: Annotation. Br J Haematol. 2001;114(2):271-80.
• 5. Hollowell J, Ruigómez A, Johansson S, Wallander M-A, García-Rodríguez LA. The incidence of bleeding complications associated with warfarin treatment in general practice in the United Kingdom. Br J Gen Pract. 2003;53(489):312-4.
• 6. McMahan DA, Smith DM, Carey MA, Zhou XH. Risk of major hemorrhage for outpatients treated with warfarin. J Gen Intern Med. 1998;13(5):311-6.
• 7. Landefeld CS, Goldman OL. Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Am J Med. 1989;87(2):144-52.
• 8. Wallvik J, Själander A, Johansson L, Bjuhr Ö, Jansson J-H. Bleeding complications during warfarin treatment in primary healthcare centers compared with anticoagulation clinics. Scand J Prim Health Care. 2007;25(2):123-8.
• 9. Fanikos J, Grasso-Correnti N, Shah R, Kucher N, Goldhaber SZ. Major bleeding complications in a specialized anticoagulation service. Am J Cardiol. 2005;96(4):595-8.
• 10. Koo S, Kucher N, Nguyen PL, Fanikos J, Marks PW, Goldhaber SZ. The effect of excessive anticoagulation on mortality and morbidity in hospitalized patients with anticoagulant-related major hemorrhage. Arch Intern Med. 2004;164(14):1557-60.
• 11. Beyth RJ, Quinn L, Landefeld CS. A multicomponent intervention to prevent major bleeding complications in older patients receiving warfarin: a randomized, controlled trial. Ann Intern Med. 2000;133(9):687-95.
• 12. Shireman TI, Mahnken JD, Howard PA, Kresowik TF, Hou Q, Ellerbeck EF. Development of a contemporary bleeding risk model for elderly warfarin recipients. Chest. 2006;130(5):1390-6.
• 13. Quirke W, Cahill MR, Perera K, Sargent J, Conway J. Warfarin prevalence, indications for use and haemorrhagic events. Ir Med J. 2007;100(3):402-4.
• 14. Zhang K, Young C, Berger J. Administrative claims analysis of the relationship between warfarin use and risk of hemorrhage including drug-drug and drug-disease interactions. J Manag Care Pharm. 2006;12(8):640-8.
• 15. van Geest-Daalderop J, Pequeriaux N, Van den Besselaar A. Variability of INR in patients on stable long-term treatment with phenprocoumon and acenocoumarol and implications for analytical quality requirements. Thromb Haemost. 2009;102(3):588-92.
• 16. Garcia DA, Regan S, Crowther M, Hylek EM. The risk of hemorrhage among patients with warfarin-associated coagulopathy. J Am Coll Cardiol. 2006;47(4):804-8.
• 17. Denizbasi A, Unluer EE, Guneysel O, Eroglu S, Kosargelir M. Complications of warfarin therapy and the correlation of the outcomes with INR levels. J Emerg Med. 2006;2(30):241-2.
• 18. Levine MN, Raskob G, Beyth RJ, Kearon C, Schulman S. Hemorrhagic complications of anticoagulant treatment: the Seventh ACCP Conference on antithrombotic and thrombolytic therapy. Chest. 2004;126(3):287S-310S.
• 19. Dentali F, Crowther MA. Management of excessive anticoagulant effect due to vitamin K antagonists. ASH Education Program Book. 2008;2008(1):266-70.
• 20. Ridker PM, Goldhaber SZ, Danielson E, Rosenberg Y, Eby CS, Deitcher SR et al. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med. 2003;348(15):1425-34.