title: A kick in the shins: the financial impact of uncontrolled warfarin use in pre-tibial haematomas.
abstract: Warfarin is increasingly prescribed in the elderly population for a number of medical conditions. Pre-tibial haematomas are a common cause of morbidity in this group. The aim of the study was to identify the proficiency of INR monitoring at a primary care level in correlation with their recommended INR range and to study the treatment outcome in this group. A retrospective single-centre study of patients diagnosed with pre-tibial haematomas was conducted over a two-year period. Length of hospital stay, time delay until operative intervention, blood transfusion and warfarin reversal requirements, social care input and cost to the NHS were considered. A total of 62 patients were admitted with pre-tibial haematomas of which 20 were on Warfarin. Females were predominantly more affected (5.6:1). The mechanism of injury was as a result of minor trauma. The mean INR level was 3.8 with a standard deviation of 3.1. Mean length of hospital stay was 11 days with a standard deviation of 13.6. Nine patients required skin grafting. Average cost for the acute episode was £3500 per patient. INR levels were significantly outwith the target range causing substantial patient morbidity and imposing a significant financial burden on the NHS. Tighter regulation at a primary care level should help reduce this risk.
authors.affiliation: Plastic & Reconstructive Surgery Department, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, United Kingdom.
authors.forename: W L
authors.initials: WL
authors.lastname: Thomson
authors.forename: A
authors.initials: A
authors.lastname: Pujol-Nicolas
authors.forename: A
authors.initials: A
authors.lastname: Tahir
authors.forename: H
authors.initials: H
authors.lastname: Siddiqui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics*; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D005260:Female; D006406:Hematoma / Q000188:drug therapy*; D006801:Humans; D019934:International Normalized Ratio; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D013977:Tibia / Q000098:blood supply*; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin