Use of blood products in patients with anticoagulant-related major bleeding: An analysis of inhospital outcomes.
Purpose. The impact of correcting elevated International Normalized Ratio (INR) values on inhospital mortality in patients with warfarin-associated major bleeding is presented. Methods. Using patient information from the database of a large U.S. health system, a retrospective analysis was conducted...
| Publicado en: | American Journal of Health-System Pharmacy Vol. 71; no. 19; pp. 1635 - 1646 |
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| Autores principales: | , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Oxford University Press / USA
10/1/2014
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103893245&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 103893245 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10792082 1X3 jtl: American Journal of Health-System Pharmacy issn: 10792082 maglogo: N pubinfo: dt: 10/1/2014 vid: 71 iid: 19 pid: 622 pub: Oxford University Press / USA artinfo: ui: 103893245 98365799 10.2146/ajhp130729 NLM25225449 103893245 ppf: 1635 ppct: 11 formats: fmt: @attributes: type: P tig: atl: Use of blood products in patients with anticoagulant-related major bleeding: An analysis of inhospital outcomes. aug: au: Menzin, Joseph Sussman, Matthew Nichols, Christine Friedman, Mark Zbrozek, Arthur affil: President, Boston Health Economics, Waltham, MA sug: subj: International Normalized Ratio Warfarin Administration and Dosage Warfarin Adverse Effects Hemorrhage Etiology Human Retrospective Design Descriptive Statistics Survival Analysis Inpatients United States Hospital Mortality Intracranial Hemorrhage Etiology Wilcoxon Rank Sum Test Fisher's Exact Test Length of Stay Data Analysis Software Aged Middle Age Male Female Confidence Intervals Funding Source Aged: 65+ years Middle Aged: 45-64 years Male Female ab: Purpose. The impact of correcting elevated International Normalized Ratio (INR) values on inhospital mortality in patients with warfarin-associated major bleeding is presented. Methods. Using patient information from the database of a large U.S. health system, a retrospective analysis was conducted to (1) evaluate inpatient practice patterns in correcting INR elevations among patients hospitalized with warfarin-related intracranial hemorrhage (ICH) or non-ICH bleeding and (2) test the hypothesis that achieving INR correction, defined as an INR of ≤1.5, at any point during the hospital stay is correlated with lower inhospital mortality. Cox proportional hazards models were constructed to assess predictors of inhospital death. Results. Among the 354 patients who met the study selection criteria, INR correction was achieved in 87.9% overall (92.5% and 85.5% of patients with ICH and non-ICH bleeds, respectively). Patients whose elevated INR values were corrected had significantly lower inhospital death rates than those with uncorrected elevations: 15.3% versus 55.6% (p = 0.010) among patients with ICH and 2.0% versus 11.8% (p = 0.017) among those with non-ICH bleeds. After adjusting for baseline demographics and comorbidities, the correlation between failure to correct INR elevations and increased mortality risk was significant only for patients with ICH (hazard ratio, 8.04; 95% confidence interval, 2.07–31.18; p = 0.003). Conclusion. Results of this study indicated that correction of elevated INR values was associated with a lower likelihood of inhospital death among warfarin-treated patients hospitalized for ICH or non-ICH major bleeding. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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