title: Predictors of hospital mortality and serious complications in patients admitted with excessive warfarin anticoagulation.
abstract: BACKGROUND
  Warfarin is the most commonly used oral anticoagulant and serious bleeding remains the most feared complication. Excessive warfarin anticoagulation (EWA) can be associated with adverse outcome. We aimed to identify the predictors of adverse clinical outcomes in patients admitted with EWA.
  
  
  METHODS
  Medical records of patients admitted with EWA from March-2004 through Feb-2015 were reviewed. EWA was defined as international normalized ratio (INR)>3.5 in patients who have been receiving warfarin. Primary outcome was death within hospital and secondary outcome was major composite complications (MCC) defined as intracranial hemorrhage (ICH), a need for transfusing ≥ 4 units packed red blood cell (PRBC), a need for surgical intervention for hemostasis or death within hospital.
  
  
  RESULTS
  267 patients (153 females and 114 male) were enrolled. 25 patients (9.4%) died during hospitalization. ICH, upper gastrointestinal bleeding and hemoptysis were more common in patients who did not survive (P-value: <0.001, 0.033 and 0.028; respectively). There was no correlation between indication for anticoagulation and death within hospital or development of MCC. In multivariate analysis, O blood group, ICH and the number of transfused PRBC and fresh frozen plasma units were identified as independent predictors of death within hospital. Lower hemoglobin concentrations and higher pulmonary pressures on admission were independent predictors of MCC, which occurred in 47 patients (17.6%).
  
  
  CONCLUSIONS
  Hospital mortality correlated with the severity of bleeding (requiring ≥ 4 units PRBC), intracranial hemorrhage and O blood group, while MCC associated with lower hemoglobin and pulmonary hypertension at the time of admission.
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, 51666 Tabriz, Iran; Department of Anesthesiology, State University of New York at Buffalo, Buffalo, NY 14214, United States.
authors.forename: Leili
authors.initials: L
authors.lastname: Pourafkari
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, 51666 Tabriz, Iran.
authors.forename: Samad
authors.initials: S
authors.lastname: Ghaffari
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, 51666 Tabriz, Iran.
authors.forename: Nasrin
authors.initials: N
authors.lastname: Khaki
authors.affiliation: Department of Anesthesiology, State University of New York at Buffalo, Buffalo, NY 14214, United States.
authors.forename: Geoffrey H
authors.initials: GH
authors.lastname: Hobika
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, 51666 Tabriz, Iran.
authors.forename: Kourosh
authors.initials: K
authors.lastname: Masnadi-Shirazi
authors.affiliation: Department of Anesthesiology, State University of New York at Buffalo, Buffalo, NY 14214, United States. Electronic address: nnader@buffalo.edu.
authors.forename: Nader D
authors.initials: ND
authors.lastname: Nader
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001241:Aspirin / Q000008:administration & dosage; D004359:Drug Therapy, Combination / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000401:mortality*; D007492:Iran / Q000453:epidemiology; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D000067490:Prescription Drug Overuse / Q000401:mortality* / Q000706:statistics & numerical data; D012307:Risk Factors; D015996:Survival Rate; D013923:Thromboembolism / Q000401:mortality / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin
keywords: Bleeding; Hemorrhage; Mortality; Warfarin