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Management of Over‐Anticoagulation in Warfarinised Hospital Patients
Author(s) -
Bajorek Beata V,
Yau Leanne,
Lee Kevin,
Zulueta Wayne
Publication year - 2009
Publication title -
journal of pharmacy practice and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.222
H-Index - 22
eISSN - 2055-2335
pISSN - 1445-937X
DOI - 10.1002/j.2055-2335.2009.tb00697.x
Subject(s) - medicine , audit , clinical audit , warfarin , emergency medicine , medical record , intensive care medicine , accounting , atrial fibrillation , business
Aim To determine the number of warfarinised hospital patients experiencing over‐anticoagulation; to identify how over‐anticoagulation is managed and whether local guidelines are adhered to. Method 2 prospective one‐week clinical audits were conducted in 2005 (Audit 1) and 2008 (Audit 2). The medical notes, drug charts and anticoagulation charts of warfarinised patients admitted to hospital were reviewed. The following data were collected: medical histories, warfarin regimen, international normalised ratio results, clinical events and over‐anticoagulation clinical management and treatment options. Results Data were collected for 58 patients (Audit 1: n = 30; Audit 2: n = 28). At least one‐third of all patients experienced over‐anticoagulation (Audit 1: 53%; Audit 2: 36%). Haemorrhagic events occurred in 40% of patients in Audit 1 and 18% in Audit 2 (p = 0.06) – not all were associated with elevated international normalised ratios. Most cases of over‐anticoagulation were managed by withholding warfarin doses and one case (Audit 2) required Prothrombinex. Drug interactions were the most common risk factor (> 50% of patients) for over‐anticoagulation in both audits. Problems with documentation were more prevalent in Audit 1 than in Audit 2. Conclusion Over‐anticoagulation is a common occurrence in warfarinised hospital patients. Hospital over‐anticoagulation management practices need to be reviewed to ensure safe and efficacious anticoagulation.