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Predictors of warfarin-associated adverse events in hospitalized patients: Opportunities to prevent patient harm.
- Source :
-
Journal of hospital medicine [J Hosp Med] 2016 Apr; Vol. 11 (4), pp. 276-82. Date of Electronic Publication: 2015 Dec 14. - Publication Year :
- 2016
-
Abstract
- Background: The optimum international normalized ratio (INR) monitoring frequency for hospitalized patients receiving warfarin is unknown.<br />Objective: Assess relationship between daily versus less frequent INR monitoring and overanticoagulation and warfarin-related adverse events.<br />Design: Retrospective cohort study using Medicare Patient Safety Monitoring System data.<br />Setting: Randomly selected acute care hospitals across the United States.<br />Patients: Patients hospitalized from 2009 to 2013 for pneumonia, acute cardiac disease, or surgery who received warfarin.<br />Interventions: None.<br />Measurements: (1) Association between frequency of INR monitoring and an INR ≥6.0 or warfarin-related adverse event. (2) Association between the rate of change of the INR and a subsequent INR ≥5.0 and ≥6.0.<br />Results: Among 8529 patients who received warfarin for ≥3 days, for 1549 (18.2%) the INR was not measured on 2 or more days. These patients had higher propensity-adjusted odds ratios (ORs) of having a warfarin-associated adverse event (OR: 1.48, 95% confidence interval [CI]: 1.02-2.17) for cardiac patients and surgical patients (OR: 1.73, 95% CI: 1.20-2.48), with no significant association for pneumonia patients. Cardiac and pneumonia patients with 1 day or more without an INR measurement had higher propensity-adjusted ORs of having an INR ≥6.0 (OR: 1.61, 95% CI: 1.07-2.41 and OR: 1.92, 95% CI: 1.36-2.71, respectively). A 1-day increase in the INR of ≥0.9 occurred in 621 patients (12.5%) and predicted a subsequent INR of ≥6.0 (positive likelihood ratio of 4.2).<br />Conclusion: Daily INR measurement and recognition of a rapidly rising INR might decrease the frequency of warfarin-associated adverse events in hospitalized patients.<br /> (© 2015 Society of Hospital Medicine.)
- Subjects :
- Aged
Aged, 80 and over
Cohort Studies
Drug Monitoring methods
Drug Monitoring trends
Forecasting
Heart Arrest chemically induced
Heart Arrest epidemiology
Humans
Intracranial Hemorrhages chemically induced
Intracranial Hemorrhages epidemiology
Medicare trends
Middle Aged
Patient Harm trends
Random Allocation
United States epidemiology
Anticoagulants adverse effects
Hospitalization trends
International Normalized Ratio trends
Patient Harm prevention & control
Warfarin adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1553-5606
- Volume :
- 11
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of hospital medicine
- Publication Type :
- Academic Journal
- Accession number :
- 26662851
- Full Text :
- https://doi.org/10.1002/jhm.2528