A Study of Elderly Adults Taking Warfarin Admitted with Prolonged International Normalized Ratio: A Community Hospital's Experience
| Autor: | Michael Bergman, Naava Blumberger, Yaacov Ori, Zachary Z. Brener, Hertzel Salman |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty Warfarin therapy Hospitals Community medicine Humans International Normalized Ratio cardiovascular diseases Elderly adults Aged Retrospective Studies Aged 80 and over Chi-Square Distribution business.industry Incidence (epidemiology) Warfarin Anticoagulants Atrial fibrillation Retrospective cohort study Middle Aged medicine.disease Community hospital Female Geriatrics and Gerontology business Major bleeding medicine.drug |
| Zdroj: | Journal of the American Geriatrics Society. 60:1713-1717 |
| ISSN: | 0002-8614 |
| DOI: | 10.1111/j.1532-5415.2012.04103.x |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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