Factors associated with failure to correct the international normalised ratio following fresh frozen plasma administration among patients treated for warfarin-related major bleeding. An analysis of electronic health records.
This study assessed the frequency and factors associated with failure to correct international normalised ratio (INR) in patients administered fresh frozen plasma (FFP) for warfarin-related major bleeding. This retrospective database analysis used electronic health records from an integrated health system. Patients who received FFP between 01/01/2004 and 01/31/2010, and who met the following criteria were selected: major haemorrhage diagnosis the day before to the day after initial FFP administration; INR ≥2 on the day before or the day of FFP and another INR result available; warfarin prescription within 90 days. INR correction (defined as INR ≤1.3) was evaluated at the last available test up to one day following FFP. A total of 414 patients met selection criteria (mean age 75 years, 53% male, mean Charlson score 2.5). Patients presented with gastrointestinal bleeding (58%), intracranial haemorrhage (38%) and other bleed types (4%). The INR of 67% of patients remained uncorrected at the last available test up to one day following receipt of FFP. In logistic regression analysis, the INR of patients who were older, those with a Charlson score of 4 or greater, and those with non-ICH bleeds (odds ratio vs. intracranial bleeding 0.48; 95% confidence interval 0.31-0.76) were more likely to remain uncorrected within one day following FFP administration. In an alternative definition of correction, (INR ≤1.5), 39% of patients' INRs remained uncorrected. For a substantial proportion of patients, the INRs remain inadequately or uncorrected following FFP administration, with estimates varying depending on the INR threshold used.
Joseph Menzin, PhD, Boston Health Economics, Inc., 20 Fox Road, Waltham, MA 02451, USA. jmenzin@bhei.com
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Menzin
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White
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Friedman
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Nichols
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Menzin
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Hoesche
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Bergman
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Jones
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000494:pharmacology; D004635:Emergency Medicine / Q000379:methods; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis; D006801:Humans; D019934:International Normalized Ratio; D020300:Intracranial Hemorrhages / Q000175:diagnosis; D008297:Male; D016347:Medical Records Systems, Computerized; D016017:Odds Ratio; D010949:Plasma / Q000378:metabolism*; D012044:Regression Analysis; D012189:Retrospective Studies; D014859:Warfarin / Q000009:adverse effects* / Q000494:pharmacology
D000925:Anticoagulants; D014859:Warfarin