Nontherapeutic international normalized ratio results in hospital emergency patients on vitamin K antagonists: prevalence and associated factors
López Altimiras X, Gené Tous E, De Giorgi A, Gadea Polo A, Martín Horcajo R, Jiménez Hernández S
Affiliation of the authors
Servicio de Urgencias, Hospital Universitario de Mollet, Barcelona, Spain. Servei d'Urgències Parc Taulí Hospital Universitari. Institut d’Investigació i Innovació Parc Taulí I3PT. Departament de Medicina Universitat Internacional de Catalunya. Centro de Investigación Biomédica en Red enfermedades hepáticas y digestivas (CIBERehd). Departamento de Medicina Universitat Interncional de Catalunya. Servicio de Urgencias, Quirónsalud Hospital Universitario General de Cataluña. Barcelona, Spain. Área de Urgencias, Hospital Clínic. Grupo UPyP, IDIBAPS. Barcelona, Spain.
López Altimiras X, Gené Tous E, De Giorgi A, Gadea Polo A, Martín Horcajo R, Jiménez Hernández S. Nontherapeutic international normalized ratio results in hospital emergency patients on vitamin K antagonists: prevalence and associated factors. Emergencias. 2017;29:93-8
Aims. To determine the prevalence of international normalized ratio (INR) findings outside the normal range in hospital emergency department patients on vitamin K antagonists (VKAs). To identify factors associated with abnormal anticoagulant levels in these patients.
Methods.
Observational, cross-sectional, multicentric study in 4 hospital emergency departments. We included a convenience sample of patients on VKA treatment for whom INR levels were on record and who had sought emergency care for complications unrelated to anticoagulant treatment.
Results.
We included 376 patients with a mean (SD) age of 76.8 (10.1) years; 50.3% were women and 86.7% had atrial fibrillation. We found that 60.4% (95% CI, 55.3%–65.2%) had INRs outside the reference range. Multivariate analysis showed that changes in the patients’ other long-term medications were independently associated with nontherapeutic INR results (odds ratio, 1.6; 95% CI, 1.02–2.79; P=.035).
Conclusions.
Over 60% of patients on VKA treatment who come to hospital emergency departments with complaints unrelated to anticoagulant therapy have INR values outside the normal range. Changes in a patient’s usual medications are significantly associated with nontherapeutic INR findings.
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