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Risk factors for elevated INR values during warfarin therapy in hospitalized pediatric patients
Author(s) -
Moffett Brady S.,
Ung Meng,
Bomgaars Lisa
Publication year - 2012
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.23308
Subject(s) - medicine , warfarin , logistic regression , incidence (geometry) , retrospective cohort study , population , emergency medicine , pediatrics , atrial fibrillation , physics , environmental health , optics
Background There are currently no data describing the incidence of or risk factors for elevated International Normalized Ratio (INR) values in patients receiving warfarin at a tertiary care pediatric hospital. By minimizing risk factors for elevated INR values patient morbidity may be minimized. Procedures A 6‐year retrospective chart review of inpatient admissions at our institution that received warfarin was performed. Factors for elevated INR values, such as patient demographics, disease state, and medication interactions were reviewed. Patients with an INR value ≥ 0.5 above the upper limit of the goal range were compared to patients without an elevated INR value. A logistic regression analysis was performed to identify independent variables for elevated INR values. Results A total of 298 patient admissions (184 patients) met study criteria, and the largest patient population was between 1 and 12 years old (36.9%). The most common indication for warfarin was mitral valve replacement (25.5%). An elevated INR occurred in 20.8% of admissions. Logistic regression analysis identified Asian race, an elevated baseline INR value, warfarin initiation after cardiac surgery, days of inpatient warfarin therapy, and drug interactions with ciprofloxacin and lansoprazole as independent variables for an elevated INR value ( P < 0.05). Obesity was significant as an independent variable for a non‐elevated INR value ( P < 0.05). Conclusions 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. Pediatr Blood Cancer 2012; 58: 941–944. © 2011 Wiley Periodicals, Inc.