title: Risk Factors for Bleeding in Hospitalized Patients with Elevated INR: No Vitamin K Therapy Received Versus Vitamin K Received.
abstract: BACKGROUND
  Supratherapeutic international normalized ratio (INR) in patients on warfarin is a common side effect. Updated guidelines recommend against using vitamin K to correct INRs 4.5 to 10 in the absence of bleeding. The impact of compliance with updated guidelines during hospitalization has not been fully explored.
  
  
  METHODS
  A retrospective, observational study was performed utilizing electronic medical records. The goal was to evaluate management of supratherapeutic INR values for medicine inpatients and identify differences in clinical outcomes among inpatients treated and not treated with vitamin K. Records from adult inpatients with at least one INR value between 4.5 and 9 were reviewed. A total of 51 records were evaluated. Thirty-four patients did not receive vitamin K compared to 17 who did. Bleeding events, readmissions rates, length of stay, and familiarity with new guidelines were studied.
  
  
  RESULTS
  Mean age of patients was 73 years, and 71% were female. No statistically significant differences were observed in bleeding events between patients who received vitamin K and those who did not: 2/17 (12%) and 1/34 (3%), respectively (P= .30). No differences in 30-day readmission rates (24% vs 18%;P= .71) or in length of stay (7 vs 4 days;P= .11) were found. All pharmacists (13 of 13) were familiar with CHEST 2012 guidelines on the management of supratherapeutic INR compared to 10 of 21 (48%) hospitalists (P= .001).
  
  
  CONCLUSIONS
  With the national focus on reduction of health care costs, health systems are looking at innovative ways to reduce readmission rates and length of stay. This study, which evaluated the use of vitamin K administration, showed no statistical difference between bleeding events, readmission rates, and length of stay in patients who received vitamin K. Education on the updates of guidelines may be beneficial, as many providers were not familiar with the changes in recommendations.
authors.affiliation: Department of Pharmacy.
authors.forename: Monique
authors.initials: M
authors.lastname: Mounce
authors.affiliation: Department of Pharmacy.
authors.forename: Candace
authors.initials: C
authors.lastname: Essel
authors.affiliation: Department of Pharmacy.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Kim
authors.affiliation: Department of Pharmacy; Division of Hospital Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
authors.forename: Che Matthew
authors.initials: CM
authors.lastname: Harris
keywords: anticoagulation; hospitalization; international normalized ratio; vitamin K; warfarin