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Bleeding risks and response to therapy in patients with INR higher than 9.
- Source :
-
American journal of clinical pathology [Am J Clin Pathol] 2012 Oct; Vol. 138 (4), pp. 546-50. - Publication Year :
- 2012
-
Abstract
- An international normalized ratio (INR) higher than 9 is associated with a high risk of bleeding, yet most studies have focused on outpatients with lower INR. We retrospectively analyzed diagnosis, bleeding, treatment, and mortality in 162 patients with INR higher than 9, including inpatients and outpatients with and without warfarin treatment. Patients without anticoagulant treatment with INR higher than 9 had a poor prognosis, 67% experienced bleeding and 74% died. Among outpatients receiving warfarin with INR higher than 9, 11% had bleeding, but none died. Among inpatients receiving warfarin, 35% had bleeding and 17% died. Factors associated with bleeding were older age, renal failure, and alcohol use. Withholding warfarin or giving vitamin K treatment was ineffective at reducing the INR within 24 hours, whereas plasma infusion immediately dropped the INR to 2.4 ± 0.9. Because of underlying disease, comorbidities, and medications, hospitalized patients with INR higher than 9 may not respond quickly to withholding warfarin or vitamin K treatment, and plasma infusion may be needed to reduce INR and the risk of bleeding within 24 hours.
- Subjects :
- Adult
Blood Transfusion
Female
Hemorrhage mortality
Hemorrhage physiopathology
Hemorrhage therapy
Humans
Infusions, Intravenous
Male
Middle Aged
Plasma
Prognosis
Retrospective Studies
Risk Assessment
Vitamin K therapeutic use
Withholding Treatment
Anticoagulants adverse effects
Blood Coagulation drug effects
Hemorrhage diagnosis
International Normalized Ratio
Warfarin adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1943-7722
- Volume :
- 138
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- American journal of clinical pathology
- Publication Type :
- Academic Journal
- Accession number :
- 23010709
- Full Text :
- https://doi.org/10.1309/AJCPJ2GMDS7BXLEO