Published: 2019-09-23

In-hospital and post discharge mortality in patients hospitalized for warfarin overdose

Ercan Aydin, Selcuk Yaylacı, Altug Osken, Salih Sahinkus


Background: This study aimed to examine the in-hospital and post-discharge mortality rates in patients followed up for warfarin overdose in the cardiology clinic and the factors affecting the mortality.

Methods: This study included patients receiving warfarin treatment for atrial fibrillation (AF) and prosthetic heart valve and those hospitalized when warfarin overdose. Furthermore, 48 patients with and without hemorrhagic complications were detected. The causes and rates of mortality of the patients during hospitalization and post discharge were monitored during a mean follow-up of three years.

Results: The mean age of 48 patients (32 [66.17%] women) hospitalized for warfarin overdose was 77±10 years. The mean hospitalization period of the patients was 5±4 days, 2±1 day in 11 patients without hemorrhage (22.9%), and 6±3 days in 37 patients with hemorrhage (77.1%). Moreover, 38 patients were receiving warfarin for AF (79.2%) and 10 patients for prosthetic heart valve (20.8%). The mean INR value before hospitalization in patients hospitalized for warfarin was 6.67±2.4, hemoglobin was 10.6±2.3, hematocrit was 33.1±7.5, platelet count was 225±64, and creatinine was 0.9±0.3. In the statistical analysis of 11 patients (22.9%) without hemorrhage and 37 patients (77.1%) hospitalized because of hemorrhage who were being followed up for warfarin overdose, hemoglobin, hematocrit, and platelet count and INR level were considerably low and high in patients with hemorrhage, respectively (Table 2). Figure 1 shows the causes of hemorrhage detected in the patients. On mortality examination, five patients (10.4%) were found to be dead.

Conclusions: Being unable to obtain the target INR level or warfarin overdose may lead to serious problem in patients using oral anticoagulants. Whether hemorrhage is observed in patients hospitalized because of warfarin overdose, close monitoring of the patient’s clinical and laboratory parameters is absolutely necessary.


Hospitalize patient, Mortality, Overdose, Warfarin

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References Accessed 24 January 2019.

Keeling D, Baglin T, Tait C, Watson H, Perry D, Baglin C, et al. British Committee for Standards in Haematology. Guidelines on oral anticoagulation with warfarin - fourth edition. Br J Haematol. 2011 Aug;154(3):311-24.

Altunbaş G, Ercan S, Davutoğlu V, Al B. Varfarin Tedavisine Genel Bakış ve Sorulara Cevaplar. JAEM 2013 Mar 1;12(1):38.

Özcan T, Altiok M, Babalikli F. Warfarin kullanan hastalara ilaca iliskin verilen grup egitiminin bilgi düzeylerine etkisi/The effect of group education about drug usage in the patient's on warfarin therapy. Anadulu Kardiyoloji Dergisi: AKD. 2013 May 1;13(3):292.

Zareh M, Davis A, Henderson S. Reversal of warfarin-induced hemorrhage in the emergency department. Western Journal of Emergency Medicine. 2011 Nov;12(4):386-92.

Alisir MF, Kecebas M, Fesli F, Caliskan S, Gungoren F, Yildirim A, et al. Effective INR levels and its relationship with etiology in warfarin patients. Clin J Med Scie Turk. 2013;33(3):868-73.

Ansell J, Hirsh J, Poller L, Bussey H, Jacobson A, Hylek E. The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(3):204-33.

Eroglu M, Cinar O, Cevik E, Yamanel L, Durusu M, Inal V, et al. Analysis of the cases admitted to the intensive care unit from the emergency department due to the complications related to warfarin treatment. Turk J Emerg Med. 2011; 11: 9-12.

Acar A, Hasbahçeci M, Başak F, ve ark, Canbak T, Çalışkan M, Alimoğlu O. Warfarin doz aşımına bağlı oluşan kanamalar. Dicle Tıp Dergisi 2012;39(2):223-6.

You JH, Chan FW, Wong RS, Cheng G. Is INR between 2.0 and 3.0 the optimal level for Chinese patients on warfarin therapy for moderate-intesity anticoagulation? Br J Clin Pharmaco 2005;59(5):582-7.

Yaylacı S, Ösken A, Aydın E, Genç AB, Şahinkuş S, Can Y, et al. İç hastalıkları polikliniğine başvuran varfarin kullanan hastalar ve etkin INR’ye ulaşma oranları. Kocaeli Med J. 2014;3(3):18-21.

Amin A, Stokes M, Makenbaeva D, Wiederkehr D, Wu N, Lawrence JH. Estimated medical cost reductions associated with use of novel oral anticoagulants vs warfarin in a real-worldn on-valvular atrial fibrillation patient population. J Med Econ. 2014 Nov 1;17(11):771-81.