Risk factors for elevated INR values during warfarin therapy in hospitalized pediatric patients

Moffett, Brady S.; Ung, M An F; Bomgaars, Lisa

doi:10.1002/pbc.23308

Cited by 16 publications

(16 citation statements)

References 17 publications

(23 reference statements)

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“…Administrative claims data were the most common sources of primary ADE detection, used in 37.5 % (15/40) of studies [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Chart review was used as a primary ADE detection method in 35 % (14/40) of studies [8,[24][25][26][27][28][29][30][31][32][33][34][35][36], and survey or patient/ parent report was used in 27.5 % (11/40) of the studies [27,32,33,[37][38][39][40][41][42][43][44]. Direct documentation by research staff was used by three studies (7.5 %) [45][46][47].…”

Section: Resultsmentioning

confidence: 99%

Racial and Ethnic Disparities in Adverse Drug Events: A Systematic Review of the Literature

Baehr

Peña

2015

J. Racial and Ethnic Health Disparities

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The 2014 National Action Plan for Adverse Drug Event Prevention has recognized adverse drug events (ADEs) as a national priority in order to facilitate a nationwide reduction in patient harms from these events. Throughout this effort, it will be integral to identify populations that may be at particular risk in order to improve care for these patients. We have undertaken a systematic review to evaluate the evidence regarding racial or ethnic disparities in ADEs with particular emphasis on anticoagulants, diabetes agents, and opioids due to the clinical significance and preventability of ADEs associated with these medication classes. From an initial search yielding 3302 studies, we identified 40 eligible studies. Twenty-seven of these included studies demonstrated the presence of a racial or ethnic disparity. There was no consistent evidence for racial or ethnic disparities in the eight studies of ADEs in general. Asians were most frequently determined to be at higher risk of anticoagulant-related ADEs, and black patients were most frequently determined to be at higher risk for diabetes agents-related ADEs. Whites were most frequently identified as at increased risk for opioid-related ADEs. However, few of these studies were specifically designed to evaluate racial or ethnic disparities, lacking a standardized approach to racial/ethnic categorization as well as control for potential confounders. We suggest the need for targeted interventions to reduce ADEs in populations that may be at increased risk, and we suggest strategies for future research.

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Section: Resultsmentioning

confidence: 99%

Racial and Ethnic Disparities in Adverse Drug Events: A Systematic Review of the Literature

Baehr

Peña

2015

J. Racial and Ethnic Health Disparities

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“…Hylek et al found that bleeding risk increased significantly in patients over 80 years who had an INR level over 4 and who had been using warfarin for more than 90 days [9]. Similarly, in a study of 184 warfarin-using patients younger than 12 years, INR levels were higher in those using warfarin for an extended duration [10]. However, Aspinall et al found that the duration of warfarin use was not an independent risk factor for increased bleeding risk in patients followed up in an anticoagulation clinic [11].…”

Section: Discussionmentioning

confidence: 99%

Determining Risk Factors of Bleeding in Patients on Warfarin Treatment

Uygungül

Ayrık

Narcı

et al. 2014

Advances in Hematology

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Background. Warfarin is a commonly used oral anticoagulant agent. The most common adverse effects of warfarin are bleeding complications. Methods. We performed a 1-year retrospective chart review of emergency department patients using warfarin. A total of 65 patients with bleeding disorder (study group) and 63 patients without bleeding (control group) were included, making up a total of 128 subjects. Demographic data, frequency of international normalized ratio (INR) checks, and routine blood results were extracted. Logistic regression analysis was used to determine which factors were most closely associated with bleeding complications. Results. Median age was 62.0 ± 14.4 and 61.9 ± 14.5 for study group and control group, respectively. Educational status and frequency of INR checks were similar in both groups (P = 0.101 and P = 0.483, resp.). INR levels were higher in the study group (5.45 ± 3.98 versus 2.63 ± 1.71, P < 0.001). Creatinine levels were also higher in the study group (1.14 ± 0.57 mg/dL versus 0.94 ± 0.38 mg/dL, P = 0.042). Acetylsalicylic acid use was more frequent in the study group and was associated with a 9-fold increase in bleeding complications (P < 0.001). Conclusions. High INR levels, high creatinine levels, and acetylsalicylic acid use were associated with bleeding complications in ED patients using warfarin.

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“…In our knowledge, there have been very few reports on this subject. The previous reports are either episodic case reports (presentation in congress) or observations for very short period (<2 weeks) [8]- [14]. This study showed that the use of PPI on top of warfarin did not change anti-coagulation action of warfarin for more than 6 weeks.…”

Section: Discussionmentioning

confidence: 76%

“…However, it is not known how this pharmacological difference among PPI is relevant to the clinical practice. In fact, there are few clinical studies on this matter [11]- [14]. Some studies pointed out that PPI increased the anti-coagulation effect of warfarin [11] [14], i.e., INR was increased, but their observation periods were too short (1 to 2 weeks) to draw a definite conclusion.…”

Section: Introductionmentioning

confidence: 99%

“…In fact, there are few clinical studies on this matter [11]- [14]. Some studies pointed out that PPI increased the anti-coagulation effect of warfarin [11] [14], i.e., INR was increased, but their observation periods were too short (1 to 2 weeks) to draw a definite conclusion. The effect of warfarin is known to fluctuate during a long-term follow-up where adverse effects could be seen [15].…”

Section: Introductionmentioning

confidence: 99%

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Interaction between Warfarin and Proton Pump Inhibitors

Shirayama¹,

Shiraishi²,

Kuroyanagi³

et al. 2014

IJCM

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Background: Interaction between proton pump inhibitors (PPI) and warfarin is controversial. Previous clinical studies have only a short follow-up period. Methods and Results: All patients (n = 716) for whom warfarin was prescribed from November 1, 2010 to October 30, 2011 were extracted from electronic health records. In retrospective analysis for 1 year, PPI were prescribed to 404 patients. Among them, 108 patients were taking warfarin for more than 6 weeks before and after PPI. The profile of these patients was analyzed: 63 patients took lansoprazole; 15 patients took omeprazole; 30 patients took rabeprazole. No statistical difference was observed among 3 groups in age, body weight, concomitant use of other drugs, and comorbidity. Warfarin dose and INR did not change after PPI. Multivariate stepwise logistic regression analysis revealed that upper quartile of increment of INR was associated with the presence of atrial fibrillation (OR 3.77, 95% CI 1.16 -12.27). The patients who had warfarin for shorter periods before PPI, or those who had PPI first (n = 141) had similar dose of warfarin and INR. In all patients analyzed (n = 404), including patients whose follow-up periods were shorter than 6 weeks (n = 155), a patient had cerebral bleeding, and 2 patients had cerebral infarction. Conclusions: Unfavorable interaction between warfarin and PPI was negligible in clinical use. Relatively higher INR was achieved after PPI in the presence of atrial fibrillation.

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Risk factors for elevated INR values during warfarin therapy in hospitalized pediatric patients

Abstract: Elevated INR values occur often in patients receiving warfarin while admitted to a tertiary care pediatric facility and modifiable risk factors exist for elevated INR values.

Cited by 16 publications

References 17 publications

Racial and Ethnic Disparities in Adverse Drug Events: A Systematic Review of the Literature

Racial and Ethnic Disparities in Adverse Drug Events: A Systematic Review of the Literature

Determining Risk Factors of Bleeding in Patients on Warfarin Treatment

Interaction between Warfarin and Proton Pump Inhibitors

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