Gastrointestinal Hemorrhage in Warfarin Anticoagulated Patients: Incidence, Risk Factor, Management, and Outcome. (29th May 2014)

• Record Type: Journal Article
• Authors: Chen, Wen-Chi; Chen, Yan-Hua; Hsu, Ping-I; Tsay, Feng-Woei; Chan, Hoi-Hung; Cheng, Jin-Shiung; Lai, Kwok-Hung
• Other Names: Chuah Seng-Kee Academic Editor.
• Is Part Of: BioMed research international. Volume 2014(2014)
• Publication Date: 2014-05-29
• Subjects: Medicine -- Periodicals; Biology -- Periodicals; Biotechnology -- Periodicals; Life sciences -- Periodicals; 610.5
• DOI: 10.1155/2014/463767
• Languages: English
• ISSNs: 2314-6133

Abstract

Abstract : Background. Warfarin reduces the incidence of thromboembolism but increases the risk of gastrointestinal bleeding (GIB). GIB during warfarin anticoagulation is rarely evaluated in Asian patients. Aims. This study aimed at investigating the incidence, risk factors, management, and outcome of GIB in Taiwanese patients treated with warfarin. Methods. We analyzed a cohort of warfarin anticoagulated patients between July 1993 and May 2012. Clinical data were retrieved in a chart-reviewing manner. Results. A total of 401 warfarin anticoagulated patients were enrolled. The incidence of GIB was 3.9% per patient-years. Multivariate analysis with Cox regression showed that age >65 years old (RR: 2.5, 95% CI: 1.2–5.5), a mean international normalized ratio >2.1 (RR: 2.1, 95% CI: 1.0–4.2), a history of GIB (RR: 5.1, 95% CI: 1.9–13.5), and cirrhosis (RR: 6.9, 95% CI: 2.0–24.5) were independent factors predicting GIB. 27.3% of the GIB patients had rebleeding after restarting warfarin while thromboembolic events were found in 16.7% of the patients discontinuing warfarin therapy. Conclusions. Warfarin was associated with a significant incidence of GIB in Taiwanese patients. The intensity of anticoagulation should be monitored closely during warfarin therapy, especially in patients with risk factors of GIB.