Assessment of factors affecting mortality in geriatric patients with warfarin overdose
Seda Dagar*(0000‐0002‐7874‐382X), Emine Emektar(0000‐0002‐6056‐4401), Hüseyin Uzunosmanoglu(0000‐0002‐4370‐1283), Yunsur Cevik(0000‐0003‐1325‐0909)
Department of Emergency Medicine, Kecioren Training and Research Hospital, Ankara, Turkey
Keywords: Ageing, anticoagulant, geriatrics, mortality, warfarin
OBJECTIVES: The aim of the present study was to perform a demographic analysis of complications and to determine the factors affecting in-hospital mortality in geriatric patients with warfarin overdose.
MATERIALS AND METHODS: All patients aged 65 years or older using warfarin with an international normalized ratio (INR) level above 3.5 IU between 01.01.2014 and 01.01.2018 were included in the study. Characteristics of patients with in-hospital mortality and surviving patients were compared. Multivariate regression analysis was used to assess the predictors for in-hospital mortality.
RESULTS: A total of 302 geriatric patients included in the study for statistical analyses. Bleeding rate was 14.2%. A comparison of patient characteristics for in-hospital mortality (survivor vs. nonsurvivor) revealed significant differences for age, gender, chronic renal failure history, creatinine, aspartate aminotransferase (AST), and alanine aminotransferase levels (P < 0.05). A multivariate logistic regression analysis was performed. It was found that elevated AST (P = 0.029, odds ratio [OR]: 1.004, 95% confidence intervals [CIs]; 1.001–1.007) and creatinine (P = 0.045, OR: 2.36, 95% CIs; 1.02–5.48) levels as well as advanced age (P = 0.031, OR: 1.11, 95% CIs; 1.01–1.22) and male gender (P = 0.017, OR: 5.48, 95% CIs; 1.35–22.1) had a negative impact on survival.
CONCLUSION: Our study results revealed that male gender, advanced age, and hepatic and renal dysfunctions were the predictors of in-hospital mortality in the elderly with warfarin overdose. In order to avoid serious warfarin-related complications in the older age groups, particularly when there is renal or hepatic dysfunction, patients should be informed about minor warning side effects of warfarin, INR levels should be more frequently checked, and patients should have more strict follow-up schedules.
Ethical approval for the present study was obtained from Kecioren Training and Research Hospital Ethics Committee (No: 2012-KAEK-15/1745) Date: 12.09.2018.
Conception: S.D., E.E., H.U.; Design and supervision: S.D., E.E., Y.C.; Data collection and processing: S.D., H.U.; Analysis and interpretation: S.D., E.E., Y.C.; Literature review: S.D., H.U.; Writer: S.D., E.E., H.U.; Critical review: E.E., Y.C.