Ministry of Health, Ankara City Hospital, Üniversiteler, Ankara, Turkey.
Drug Chem Toxicol. 2022 Jul;45(4):1732-1738. doi: 10.1080/01480545.2020.1868493. Epub 2021 Jan 25.
The aim of this study was to investigate risk factors of bleeding and mortality in patients with warfarin overdose (WOD). Totally, 783 patients were included, of which, 272 patients (34.7%) with an INR below 5,364 patients (46.5%) with an INR between 5-10, and 147 patients (18.8%) with an INR of 10 or above. Demographic, clinical, and laboratory findings of the patients were obtained from the Real Life Data Provision Center and Hospital Information Management System. Admittance in autumn ( = 1.75; = 0.012), INR = 5-10 ( = 2.65; < 0.001), INR ≥ 10 ( = 9.06; < 0.001), and antiplatelet use alongside warfarin ( = 1.93; < 0.001) were found to be independent risk factors for bleeding in this study. The age (OR= 1.03; = 0.005), bleeding (OR = 1.69; = 0.020), primary hypertension (OR = 1.72; = 0.031), and INR ≥ 10 ( = 2.02; = 0.025) were found to be independent risk factors for mortality. The cutoff value for INR in predicting bleeding was found to be >6.35 with 74.2% sensitivity and 72.7% specificity. The significant risk factors were determined in WOD development. INR level, autumn, and antiplatelet use were independently associated with bleeding due to WOD. In addition, bleeding, hypertension and INR levels were independently related to in-hospital-mortality due to WOD.
本研究旨在探讨华法林过量（WOD）患者出血和死亡的危险因素。共纳入 783 例患者，其中 INR＜5 的 272 例（34.7%），INR 为 5-10 的 364 例（46.5%），INR≥10 的 147 例（18.8%）。患者的人口统计学、临床和实验室资料均从真实世界数据提供中心和医院信息管理系统中获得。本研究发现，秋季入院（ = 1.75； = 0.012）、INR=5-10（ = 2.65； < 0.001）、INR≥10（ = 9.06； < 0.001）和华法林联合抗血小板治疗（ = 1.93； < 0.001）是出血的独立危险因素。年龄（OR=1.03； = 0.005）、出血（OR=1.69； = 0.020）、原发性高血压（OR=1.72； = 0.031）和 INR≥10（ = 2.02； = 0.025）是死亡的独立危险因素。预测出血的 INR 临界值为>6.35，其敏感性为 74.2%，特异性为 72.7%。确定了 WOD 发展的重要危险因素。INR 水平、秋季和抗血小板治疗与 WOD 相关出血独立相关。此外，出血、高血压和 INR 水平与 WOD 院内死亡率独立相关。
