Warfarin 복용 고령 환자의 출혈 현황 및 위험성 예측
Evaluation of the Bleeding Risk Indices in Elderly Korean Patients with Warfarin
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초록
Warfarin, an effective agent for the prevention of serious thromboembolism, frequently causes bleeding complication, especially in elderly patients. In the literature, a number of different bleeding risk indices were proposed to predict the bleeding risk in patients with warfarin. However, the predictability of these indices has not been systemically evaluated in Korean patients. Therefore, the aims of the study were to determine the bleeding rate in elderly Korean patients treated with warfarin and to evaluate the predictability of the bleeding risk indices by comparing the indices with the actual bleeding rate. Electronic Medical Records(EMRs) of the patients enrolled in Anti-Coagulation Service(ACS) in Seoul National University Bundang Hospital(SNUBH) between May 10, 2003 and March 31, 2007 were reviewed. Patients, who were over the age of 65 years and received warfarin for at least 90 days with a targeted therapeutic International Normalized Ratio(INR) of 2.0~3.0, were participated in the present study. The patients were divided into 3 risk groups(i.e., low, moderate, high), as defined by the indices. Bleeding was considered ‘major’if the location was either intracranial or retroperitoneal, if the bleeding was associated with a decline in hemoglobin concentration of at least 2g/dL, or if a transfusion of 2U or more of red blood cells was necessary. Within one year, out of 323 patients, 94(29%) patients have experienced bleeding; 11 cases were classified as major bleeding. Major bleeding rates according to Shireman et al were 2.5%(5/197) and 5.2%(6/116) for the groups with low and moderate risk, respectively. No major bleeding was found in the high risk group based on the Shireman index. Major bleeding rates according to Kuijer et al were 3.3%(10/306) and 5.9%(1/17) for the groups with moderate and high risk, respectively. Major bleeding rates according to Beyth et al were 3.3%(9/271) and 3.8%(2/52) for the groups with moderate and high risk, respectively. There was no statistically significant difference among the bleeding risk groups. Further study will be necessary for the development of bleeding risk index optimized for elderly Korean patients.
Abstract
Warfarin, an effective agent for the prevention of serious thromboembolism, frequently causes bleeding complication, especially in elderly patients. In the literature, a number of different bleeding risk indices were proposed to predict the bleeding risk in patients with warfarin. However, the predictability of these indices has not been systemically evaluated in Korean patients. Therefore, the aims of the study were to determine the bleeding rate in elderly Korean patients treated with warfarin and to evaluate the predictability of the bleeding risk indices by comparing the indices with the actual bleeding rate. Electronic Medical Records(EMRs) of the patients enrolled in Anti-Coagulation Service(ACS) in Seoul National University Bundang Hospital(SNUBH) between May 10, 2003 and March 31, 2007 were reviewed. Patients, who were over the age of 65 years and received warfarin for at least 90 days with a targeted therapeutic International Normalized Ratio(INR) of 2.0~3.0, were participated in the present study. The patients were divided into 3 risk groups(i.e., low, moderate, high), as defined by the indices. Bleeding was considered ‘major’if the location was either intracranial or retroperitoneal, if the bleeding was associated with a decline in hemoglobin concentration of at least 2g/dL, or if a transfusion of 2U or more of red blood cells was necessary. Within one year, out of 323 patients, 94(29%) patients have experienced bleeding; 11 cases were classified as major bleeding. Major bleeding rates according to Shireman et al were 2.5%(5/197) and 5.2%(6/116) for the groups with low and moderate risk, respectively. No major bleeding was found in the high risk group based on the Shireman index. Major bleeding rates according to Kuijer et al were 3.3%(10/306) and 5.9%(1/17) for the groups with moderate and high risk, respectively. Major bleeding rates according to Beyth et al were 3.3%(9/271) and 3.8%(2/52) for the groups with moderate and high risk, respectively. There was no statistically significant difference among the bleeding risk groups. Further study will be necessary for the development of bleeding risk index optimized for elderly Korean patients.
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