title: A study of elderly adults taking warfarin admitted with prolonged international normalized ratio: a community hospital's experience.
abstract: OBJECTIVE
  To assess bleeding complications and outcome of individuals receiving oral anticoagulants who were admitted to the hospital with an international normalized ratio (INR) greater than 4 by comparing them according to age (≤ 80, >80).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Community hospital.
  
  
  METHODS
  All individuals (N = 253) admitted to the Department of Internal Medicine over a period of 4 years with an INR greater than 4: Group I, aged 80 and younger (n = 127); Group II, older than 80 (n = 126). Data included bleeding complications, survival, and quality of INR control before admission and up to 48 months after admission.
  
  
  RESULTS
  Atrial fibrillation was the most common indication for warfarin therapy. Its incidence was higher in the older group (88% vs 73%, P = .004). More elderly participants lived in nursing homes (23% vs 9.4%. P = .004) or received in-home assistance (38.9% vs 20.5%, P = .002). There was no difference in INR upon admission, duration of warfarin treatment, or frequency of INR tests before admission. The incidence of bleeding events was 18.1% in Group I and 12.7% in Group II (P = .30). Major bleeding events occurred in 1.6% of Group I and none of Group II (P = .50). During follow-up after the first admission, the incidence of INR greater than 4 was higher in Group II (87.3% vs 70%, P = .02), without a difference in the number of additional admissions or bleeding events.
  
  
  CONCLUSIONS
  Primary care physicians can safely maintain warfarin treatment in elderly adults, even in those with a history of hospitalization for high INR, using frequent INR measurements.
authors.affiliation: Department of Internal Medicine "C,", Rabin Medical Center, Hasharon Hospital, Petah-Tiqva, Israel. bermanm@clalit
authors.forename: Michael
authors.initials: M
authors.lastname: Bergman
authors.forename: Yaacov
authors.initials: Y
authors.lastname: Ori
authors.forename: Naava
authors.initials: N
authors.lastname: Blumberger
authors.forename: Zachary Z
authors.initials: ZZ
authors.lastname: Brener
authors.forename: Hertzel
authors.initials: H
authors.lastname: Salman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin