Audit of anticoagulant therapy and acute hospital admissions.
We conducted an audit on the contribution of failure of control of anticoagulant therapy to acute hospital admissions. Over a period of 3 months there were 1480 acute admissions. One-hundred-and-twelve (7.6%) of these patients were on anticoagulant therapy. One-hundred-and-three of these 112 patients were evaluated, 74 patients had international normalized ratios (INRs) in the therapeutic range, of whom four (5.4%) bled from causes unlikely to be due directly to anticoagulant therapy. Twenty-nine patients were over-anticoagulated. Of these, 17 (59%) were admitted with bleeding symptoms, which may have been a consequence of high INR, while one had a very high INR but no bleeding. Eleven more patients were admitted for reasons unrelated to anticoagulant therapy but were found to have over-therapeutic INRs, which may have influenced their subsequent hospital management. The only clear difference between the bleeding and nonbleeding groups was age. Reasons for over-anticoagulation were poor patient compliance in 31%, influence of other medications in 17, congestive heart failure in 28%, and unknown in 24%. In conclusion, 22/1480 hospital admissions (1.5%) were due to warfarin complications and 16/21 bleeding patients had INRs > 4.5. These are admissions that could potentially be avoided with better anticoagulation control.
Hirri
H M
HM
Haematology Department, Central Laboratory, St. Mary's Hospital, Portsmouth, UK. Hussain.Hirri@porthosp.nhs.uk
Green
P J
PJ
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004347:Drug Interactions; D062787:Drug Overdose; D004630:Emergencies; D005260:Female; D006333:Heart Failure; D006470:Hemorrhage / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010349:Patient Compliance; D012307:Risk Factors
D000925:Anticoagulants