title: Risk of major hemorrhage for outpatients treated with warfarin.
abstract: OBJECTIVE
  To determine the incidence of major hemorrhage among outpatients started on warfarin therapy after the recommendation in 1986 for reduced-intensity anticoagulation therapy was made, and to identify baseline patient characteristics that predict those patients who will have a major hemorrhage.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A university-affiliated Veterans Affairs Medical Center.
  
  
  METHODS
  Five hundred seventy-nine patients who were discharged from the hospital after being started on warfarin therapy.
  
  
  RESULTS
  The primary outcome variable was major hemorrhage. In our cohort of 579 patients, there were 40 first-time major hemorrhages with only one fatal bleed. The cumulative incidence was 7% at 1 year. The average monthly incidence of major hemorrhage was 0.82% during the first 3 months of treatment and decreased to 0.36% thereafter. Three independent predictors of major hemorrhage were identified: a history of alcohol abuse, chronic renal insufficiency, and a previous gastrointestinal bleed. Age, comorbidities, medications known to influence prothrombin levels, and baseline laboratory values were not associated with major hemorrhage.
  
  
  CONCLUSIONS
  The incidence of major hemorrhage in this population of outpatients treated with warfarin was lower than previous estimates of major hemorrhage measured before the recommendation for reduced-intensity anticoagulation therapy was made, but still higher than estimates reported from clinical trials. Alcohol abuse, chronic renal insufficiency, and a previous gastrointestinal bleed were associated with increased risk of major hemorrhage.
authors.affiliation: Richard L. Roudebush VAMC, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: McMahan
authors.forename: D M
authors.initials: DM
authors.lastname: Smith
authors.forename: M A
authors.initials: MA
authors.lastname: Carey
authors.forename: X H
authors.initials: XH
authors.lastname: Zhou
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000453:epidemiology; D000553:Ambulatory Care; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin