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Objectives: To analyze the environmental factors associated to anticoagulation excess in adult patients who come to an emergency department of a tertiary hospital. To describe the characteristics of anticoagulant therapy, their diseases and associated drugs, clinical presentation and treatment received., Methods: Prospective study of randomized patients conducted in the Emergency Department of Hospital Gregorio Marañón in Madrid during 6 months. Those patients whose INR was greater than or equal to 6 due to having taken acenocoumarol were included. Variables collected for all of them were: age, gender, INR when coming to the emergency department, anticoagulation indication, its beginning and duration, physician anticoagulation controlling, time since previous INR control, last INR assessment, treatment changes. Other variables were: comorbidity, associated medications, dietary changes, presence of bleeding, its location and treatment received. The statistical analysis was performed with the SPSS program (vs 13)., Results: A total of 49 adult patients, 63.3% female, whose average age was 77.9 (48-94) were included. Mean INR value was 8.2 (6-12). Indication due to atrial fibrillation was found in 71.4%. The most common associated diseases were heart failure and chronic nephropathy (18.4% and 16.3%, respectively). Twelve patients (24.5%) had consumed paracetamol recently. Active hemorrhage occurred in 34.7% of cases., Conclusions: Anticoagulation excess is a common problem in people over 70, where comorbidity and medications may determine the INR value. Bleeding risk is significant so that this group of patients should be closely monitored.

Objective: To establish the prevalence of liver focal pathology in patients with increase of alkaline phosphatase and gamma-glutamil transpeptidase and normal bilirubin (dissociated cholestasis), and to analyze the related risk factors for such pathology., Methods: All laboratory studies of patients admitted to an Internal Medicine Department were reviewed prospectively throughout a period of 9 months. For the purpose of detecting focal liver pathology imaging liver studies (echography and/or CT) were carried out in those in which biochemical analyses showed dissociated cholestasis., Results: A dissociated cholestasis pattern was found in 81 patients. In 13 of them (16%) focal liver pathology was demonstrated. The majority of the lesions (10 of 13) were local or metastatic malignant neoplasms. Sex, alcohol consumption, presence of diabetes mellitus, tumor or hepatobiliar disease previously known, or abnormalities in liver physical examination were not risk factors. No liver pathology was found in patients with an alkaline phosphatase level higher than double of gamma-glutamil transpeptidase level (sensitivity: 100%; negative predictive value: 100%). Diagnosis of a non-hepatic malignant neoplasm at discharge was associated to a risk 12 times bigger for the presence of liver lesions (p < 0.01)., Conclusions: It is uncommon to find focal liver pathology in patients with dissociated cholestasis. It is more common to discover focal liver pathology in patients with non-hepatic tumors and less probable when phosphatase alcaline: gamma-glutamil transpeptidase ratio is higher than two.