Original ArticlesAcute GI Bleeding in the Setting of Supratherapeutic International Normalized Ratio in Patients Taking Warfarin: Endoscopic Diagnosis, Clinical Management, and Outcomes
Section snippets
Study Design
This is a retrospective study of a cohort of patients treated with warfarin anticoagulation admitted to a single Veterans Affairs Medical Center with acute GIB. A standardized data collection form was designed before chart review; one investigator (T.A.R.) abstracted all charts. The electronic discharge summaries of all patients hospitalized with evidence of major acute GIB between January 1996 and December 2000 were reviewed. The start date of 1996 was selected because this was the year in
Results
By using the ICD-9-CM codes, there were 2979 hospitalizations identified as potential cases of GIB. Of these, 1248 episodes met study criteria for acute major GIB. Cross-referencing with the pharmacy database identified 165 patients (13.2%) who were taking warfarin at the time of the index episode of GIB. Of these, 7 had no INR value reported, 43 had an INR of less than 2.0, 53 had an INR in the range 2.0 to 3.9 (of which 10 charts were unavailable), and 62 had an INR value of 4.0 or greater
Discussion
Acute GIB in anticoagulated patients presents a challenge. The optimal management of these patients with regard to the role of endoscopy has not been established. Initial management for such patients is primarily the reversal of anticoagulation and the re-establishment of normal hemostatic mechanisms. This can be done safely, as symptomatic thromboembolism after transient withdrawal of long-term anticoagulation is uncommon.11 In the pre-endoscopy era, the etiology of bleeding was often
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Presented at the annual Digestive Diseases Week, May 20-23, 2001, Atlanta, Georgia (Gastrointest Endosc 2001;53:AB4391).