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Koo et al¹ reported an interesting study confirming that major bleeding associated with excessive anticoagulation with warfarin is also associated with an increase in mortality compared with nonexcessive anticoagulation. They state that their study findings confirm that errors in drug monitoring are the main cause of excessive anticoagulation. Although this is a logical conclusion to reach, it is not supported by the published results. I would be interested to see if they had collected data on international normalized ratio (INR) monitoring prior to the major bleeding event to ensure that adequate monitoring had been performed.

A case-control study by Kucher et al² showed that penultimate INRs (obtained a mean ± SD of 11.6 ± 17.8 days prior to a major bleeding event) were poor predictors of major bleeding and were similar to antepenultimate INRs (obtained 18.4 ± 20.5 days prior to a major bleeding event). This study showed that there is only a brief warning period . . . [Full Text of this Article]

AUTHOR INFORMATION
Rachel Howard, MRPharmS

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