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J Gen Intern Med. 1998 May;13(5):311-6.

Risk of major hemorrhage for outpatients treated with warfarin.

Author information

1
Richard L. Roudebush VAMC, Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.

Abstract

OBJECTIVE:

To determine the incidence of major hemorrhage among outpatients started on warfarin therapy after the recommendation in 1986 for reduced-intensity anticoagulation therapy was made, and to identify baseline patient characteristics that predict those patients who will have a major hemorrhage.

DESIGN:

Retrospective cohort study.

SETTING:

A university-affiliated Veterans Affairs Medical Center.

PATIENTS:

Five hundred seventy-nine patients who were discharged from the hospital after being started on warfarin therapy.

MEASUREMENTS AND MAIN RESULTS:

The primary outcome variable was major hemorrhage. In our cohort of 579 patients, there were 40 first-time major hemorrhages with only one fatal bleed. The cumulative incidence was 7% at 1 year. The average monthly incidence of major hemorrhage was 0.82% during the first 3 months of treatment and decreased to 0.36% thereafter. Three independent predictors of major hemorrhage were identified: a history of alcohol abuse, chronic renal insufficiency, and a previous gastrointestinal bleed. Age, comorbidities, medications known to influence prothrombin levels, and baseline laboratory values were not associated with major hemorrhage.

CONCLUSIONS:

The incidence of major hemorrhage in this population of outpatients treated with warfarin was lower than previous estimates of major hemorrhage measured before the recommendation for reduced-intensity anticoagulation therapy was made, but still higher than estimates reported from clinical trials. Alcohol abuse, chronic renal insufficiency, and a previous gastrointestinal bleed were associated with increased risk of major hemorrhage.

PMID:
9613886
PMCID:
PMC1496955
DOI:
10.1046/j.1525-1497.1998.00096.x
[Indexed for MEDLINE]
Free PMC Article

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