risk of hemorrhage with warfarin-associated coagulopathy

30 Nov

study by Garcia et al:

  • 979 patients seen in community-based cardiology practices with
    • warfarin-treated
    • asymptomatic 
    • INR value ≥5
  • 96% (n = 937) had INR 5-9
  • 13 patients (1.3%) experienced major hemorrhage during the 30-day follow-up period
  • major hemorrhage = bleeding that was
    • fatal,
    • led to hospitalization with transfusion of at least 2 U of packed red blood cells,
    • occurred at a critical site (e.g., intracranial, retroperitoneal)
  • 0.96% experienced major hemorrhage among patients whose INR was >5 and <9.
  • None of the bleeding events was fatal.

 

  • Intervention with vitamin K was uncommon (8.7%).
  • Most patients were managed by withholding subsequent warfarin doses
  • 50% of patients who were managed conservatively and retested on day 4 or 5 had an INR of 2.0 or less.

BOTTOM LINE:

asymptomatic INR 5-9 in patients on warfarin: low risk for major bleed (~1%)

treatment options include holding warfarin doses (seems to work ok, for the most part), vitamin K

 

References: article; picture

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