The Analysis of Cases Admitted to Intensive Care Units from Emergency Department Due to Complications Related to Warfarin Treatment

Abstract

Most of cases that were admitted because of complications related to warfarin therapy are successfully treated in the emergency department, except only for a small group which intensive care hospitalization is required. In our study, we aimed to introduce the demographic and clinical characteristics of this group needed to intensive care unit hospitalization. The recordings of 30 patients who were admitted to our emergency department (ED) and required intensive care unit hospitalization because of the complications related to warfarin therapy were retrospectively reviewed. Patients were evaluated according to age, sex, bleeding region, comorbid diseases, INR (International Normalized Ratio) levels, treatments and outcomes. Average age of patients were 66.9±12 and 57% of the patients were female. 80% of patients (n=24) had 2 and over comorbid disease. Average INR level have been determined as 9.46. INR levels were over 4 in 2 patients, between 4-10 in 15 patients and over 10 in13 patients. The most common observed bleeding region was in gastrointestinal system with 13 patients (43%) and subsequently in genitourinary system with 8 patients (26%). Intravenous vitamin K therapy to 25 patients (83%), FFP (fresh frozen plasma) therapy to 23 patients (76%) and erythrocyte suspension therapy to 13 patients (43%) have been applied. Mortality was observed in two patients and these patients’ INR levels were below 10. As a result, besides bleeding, old age, comorbid disease and high INR levels seems to be important factors in the decision of intensive care hospitalization. The gastrointestinal and genitourinary bleeding is most frequently seen. Vitamin K and FFP application were required for significant proportion of the patients who are hospitalized in intensive care unit. Any significant relationship between INR levels and mortality has not been observed.