The approach to the patients who high level of INR due to treatment of warfarin in Dokuz Eylül University Faculty of Medicine Emergency Medicine Department: One year retrospective screening

INTRODUCTION: In this research, we aimed to examine retrospectively the demographical and clinical profile of patients with high level of INR during warfarin treatment who presented to the Emergency Department of Hospital of Dokuz Eylül University (ED) in one year period. Also the clinical management and major bleeding characteristics were examined. METHOD: The population of our research which is retrospective annual file scanning, includes adult patients with age over 18 presented to ED during a one year period. The patients were grouped according to their initial INR level. INR<2, non-therapeutic exposure (Superwarfarin etc.) or increased INR due to other thn warfarin treatment had been excluded from the study. Those, who had had INR ? 2, divided into four groups according to their INR levels. In these groups, major bleeding, clinical process, diagnosis, treatment and outcomes were compared. RESULTS: 450 patients were included to the study. The major bleeding were detected in 40 patients (16.5%) in INR 2-3 group, 31 (25.8%) in INR 3-5 group, 17 (34%) in INR 5-8 group, and 19 (50%) in INR?8group (total 107) (p=0.000). The most common clinical indications for anticoagulation were atrial fibrillation (43.6%) and mechanical valve diseases (30%). While the level of INR is low with IV liquid treatment is high also blood products treatment are compatible with; vitamin K treatment was not compatible with levels of INR. While %70 of the patients were discharged, %24.5 of them were admitted to the services and % 3.1 of them were dead. In the level of therapeutic INR, both discharge and death were high significantly. While having major bleeding did not have a significant effect to the patients outcome directly, there was a significant relation between INR? 8 and death, length of stay in the ED, admitting to clinics and intensive care (p=0.000). CONCLUSION: A significant relation was found between level of INR and major bleeding, taking treatment, choice of treatment, outcome, death inside ED, the length of stay in the ED and admitting to clinics and intensive care.