title: Readmissions for warfarin-related bleeding in pediatric patients after hospital discharge.
abstract: BACKGROUND
  Warfarin therapy in pediatric patients can be difficult to manage with bleeding as a primary adverse event. Therapy initiation can be difficult as doses to achieve therapeutic outcomes are being determined. Evaluation of readmission for bleeding in pediatric patients discharged on warfarin therapy may be useful to prevent adverse events.
  
  
  METHODS
  The Pediatric Health Information System (PHIS) was queried to identify all patients <19 years of age who were discharged from a pediatric hospital on warfarin therapy. Patients who were readmitted with bleeding in the first 30 days after discharge were identified and patient variables, hospital stay variables, and medications at discharge were identified. Univariate and multivariate analysis was performed to identify independent risk factors for bleeding readmission.
  
  
  RESULTS
  A total of 4,883 patients met study criteria (56% male, mean age 10.1 + 5.9 years). The two most common indications for warfarin therapy were cardiac valve replacement (23.6%) and Fontan procedure (19.5%). Ninety-seven patients (1.99%) were readmitted with bleeding within 30 days of discharge [median time 9 days (IQR 5-16 days)]. Multivariate analysis identified Asian race (OR 4.0, P < 0.01); mitral valve replacement (OR 2.5, P < 0.01); escitalopram at discharge (OR 4.2, P = 0.02); levofloxacin at discharge (OR 8.3, P < 0.01); lansoprazole at discharge (OR 1.7, P = 0.047); and length of stay (OR 1.01, P = 0.047) as significant for bleeding readmission.
  
  
  CONCLUSIONS
  Pediatric patients discharged on warfarin may be readmitted for bleeding within 30 days if risk factors are present. Risk factors include patient genetic profile, drug interactions, and indications with higher goal INR values.
authors.affiliation: Department of Pharmacy, Texas Children's Hospital, Houston, Texas 77030, USA. bsmoffet@texaschildrens.org
authors.forename: Brady S
authors.initials: BS
authors.lastname: Moffett
authors.forename: Shelly
authors.initials: S
authors.lastname: Kim
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Bomgaars
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001213:Asian; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015283:Citalopram / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006751:Hospital Information Systems; D006801:Humans; D019934:International Normalized Ratio; D064704:Levofloxacin; D008297:Male; D015242:Ofloxacin / Q000008:administration & dosage / Q000009:adverse effects; D010359:Patient Readmission; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology*; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D013997:Time Factors; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D015283:Citalopram; D064704:Levofloxacin; D015242:Ofloxacin; D017367:Selective Serotonin Reuptake Inhibitors; D014859:Warfarin
keywords: bleeding; pediatric; readmission; warfarin