[Oral anticoagulation excess: analysis from an emergency department].
OBJECTIVE
To analyze the environmental factors associated to anticoagulation excess in adult patients who come to an emergency department of a tertiary hospital. To describe the characteristics of anticoagulant therapy, their diseases and associated drugs, clinical presentation and treatment received.


METHODS
Prospective study of randomized patients conducted in the Emergency Department of Hospital Gregorio Marañón in Madrid during 6 months. Those patients whose INR was greater than or equal to 6 due to having taken acenocoumarol were included. Variables collected for all of them were: age, gender, INR when coming to the emergency department, anticoagulation indication, its beginning and duration, physician anticoagulation controlling, time since previous INR control, last INR assessment, treatment changes. Other variables were: comorbidity, associated medications, dietary changes, presence of bleeding, its location and treatment received. The statistical analysis was performed with the SPSS program (vs 13).


RESULTS
A total of 49 adult patients, 63.3% female, whose average age was 77.9 (48-94) were included. Mean INR value was 8.2 (6-12). Indication due to atrial fibrillation was found in 71.4%. The most common associated diseases were heart failure and chronic nephropathy (18.4% and 16.3%, respectively). Twelve patients (24.5%) had consumed paracetamol recently. Active hemorrhage occurred in 34.7% of cases.


CONCLUSIONS
Anticoagulation excess is a common problem in people over 70, where comorbidity and medications may determine the INR value. Bleeding risk is significant so that this group of patients should be closely monitored.
Nuevo González
J A
JA
Servicio de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, España. jose_nuevo@hotmail.com
Cano Ballesteros
J C
JC
Pintor Holguín
E
E
Braun Saro
B
B
Visús Soler
E
E
Sevillano Fernández
J A
JA
D000074:Acenocoumarol / Q000009:adverse effects* / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D004632:Emergency Medical Services; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D019934:International Normalized Ratio; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D000925:Anticoagulants; D000074:Acenocoumarol