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The Effect of Excessive Anticoagulation on Mortality and Morbidity in Hospitalized Patients With Anticoagulant-Related Major Hemorrhage
Sophia Koo, BS;
Nils Kucher, MD;
Paul L. Nguyen, AB;
John Fanikos, RPh, MBA;
Peter W. Marks, MD, PhD;
Samuel Z. Goldhaber, MD
Arch Intern Med. 2004;164:1557-1560.
Background We aimed to determine the effect of excessive anticoagulation on morbidity and mortality in hospitalized patients with major anticoagulant-associated hemorrhage.
Methods We prospectively identified 101 consecutive inpatients admitted to Brigham and Women's Hospital with major bleeding occurring during administration of warfarin sodium, unfractionated heparin (UFH), or low-molecular-weight heparin (LMWH).
Results Fifty patients had excessive and 51 had nonexcessive anticoagulation. The overall mortality at 60 days was 26% (13/50) in the excessive group compared with 10% (5/51) in the nonexcessive group (P = .03). Excessive warfarin therapy was associated with an increased 60-day mortality (P = .049), in contrast to excessive anticoagulation with UFH or LMWH alone (P = .27) or UFH or LMWH as a "bridge" to warfarin therapy (P = .10). Multivariate regression identified excessive anticoagulation as an independent predictor of 60-day mortality (adjusted hazard ratio [HR], 4.17; 95% confidence interval [CI], 1.39-12.49; P = .01), along with intracranial hemorrhage (adjusted HR, 6.16; 95% CI, 1.75-21.67; P = .005) and active cancer (adjusted HR, 3.79; 95% CI, 1.13-12.70; P = .03). Excessive anticoagulation was also a significant predictor of the combined nonfatal end point of stroke, myocardial infarction, hypotension, critical anemia, and surgical or angiographic intervention at 30 days (HR, 2.17; 95% CI, 1.25-3.78; P = .006).
Conclusion In a cohort of patients with anticoagulation-associated hemorrhage, excessive anticoagulation contributed independently to increased morbidity and mortality.
From the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. The authors have no relevant financial interest in this article.
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