title: Use of blood products in patients with anticoagulant-related major bleeding: an analysis of inhospital outcomes.
abstract: OBJECTIVE
  The impact of correcting elevated International Normalized Ratio (INR) values on inhospital mortality in patients with warfarin-associated major bleeding is presented.
  
  
  METHODS
  Using patient information from the database of a large U.S. health system, a retrospective analysis was conducted to (1) evaluate inpatient practice patterns in correcting INR elevations among patients hospitalized with warfarin-related intracranial hemorrhage (ICH) or non-ICH bleeding and (2) test the hypothesis that achieving INR correction, defined as an INR of ≤1.5, at any point during the hospital stay is correlated with lower inhospital mortality. Cox proportional hazards models were constructed to assess predictors of inhospital death.
  
  
  RESULTS
  Among the 354 patients who met the study selection criteria, INR correction was achieved in 87.9% overall (92.5% and 85.5% of patients with ICH and non-ICH bleeds, respectively). Patients whose elevated INR values were corrected had significantly lower inhospital death rates than those with uncorrected elevations: 15.3% versus 55.6% (p = 0.010) among patients with ICH and 2.0% versus 11.8% (p = 0.017) among those with non-ICH bleeds. After adjusting for baseline demographics and comorbidities, the correlation between failure to correct INR elevations and increased mortality risk was significant only for patients with ICH (hazard ratio, 8.04; 95% confidence interval, 2.07-31.18; p = 0.003).
  
  
  CONCLUSIONS
  Results of this study indicated that correction of elevated INR values was associated with a lower likelihood of inhospital death among warfarin-treated patients hospitalized for ICH or non-ICH major bleeding.
authors.affiliation: Joseph Menzin, Ph.D., is President; Matthew Sussman, M.A., is Associate Managing Director; Christine Nichols, M.A., is Research and Data Analyst II; and Mark Friedman, M.D., is Medical Director, Boston Health Economics, Waltham, MA. Arthur Zbrozek, Ph.D., is Senior Director, Global Health Economics, CSL Behring, King of Prussia, PA. jmenzin@bhei.com.
authors.forename: Joseph
authors.initials: J
authors.lastname: Menzin
authors.affiliation: Joseph Menzin, Ph.D., is President; Matthew Sussman, M.A., is Associate Managing Director; Christine Nichols, M.A., is Research and Data Analyst II; and Mark Friedman, M.D., is Medical Director, Boston Health Economics, Waltham, MA. Arthur Zbrozek, Ph.D., is Senior Director, Global Health Economics, CSL Behring, King of Prussia, PA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Sussman
authors.affiliation: Joseph Menzin, Ph.D., is President; Matthew Sussman, M.A., is Associate Managing Director; Christine Nichols, M.A., is Research and Data Analyst II; and Mark Friedman, M.D., is Medical Director, Boston Health Economics, Waltham, MA. Arthur Zbrozek, Ph.D., is Senior Director, Global Health Economics, CSL Behring, King of Prussia, PA.
authors.forename: Christine
authors.initials: C
authors.lastname: Nichols
authors.affiliation: Joseph Menzin, Ph.D., is President; Matthew Sussman, M.A., is Associate Managing Director; Christine Nichols, M.A., is Research and Data Analyst II; and Mark Friedman, M.D., is Medical Director, Boston Health Economics, Waltham, MA. Arthur Zbrozek, Ph.D., is Senior Director, Global Health Economics, CSL Behring, King of Prussia, PA.
authors.forename: Mark
authors.initials: M
authors.lastname: Friedman
authors.affiliation: Joseph Menzin, Ph.D., is President; Matthew Sussman, M.A., is Associate Managing Director; Christine Nichols, M.A., is Research and Data Analyst II; and Mark Friedman, M.D., is Medical Director, Boston Health Economics, Waltham, MA. Arthur Zbrozek, Ph.D., is Senior Director, Global Health Economics, CSL Behring, King of Prussia, PA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Zbrozek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D016913:Blood Component Transfusion / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D019934:International Normalized Ratio; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000628:therapy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014481:United States; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin