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Factors Associated With INR Elevation and Bleeding Complications During Warfarin Therapy
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In their study, Kucher et al1 reported a brief warning period after the observation of a slightly elevated international normalized ratio (INR) that predicted imminent bleeding in patients undergoing long-term warfarin therapy. However, the authors did not specifically address the causes of INR elevation and whether these causes could have been avoided. The authors point out that, compared with control subjects without bleeding events, patients with warfarin-related hemorrhage were significantly more likely to be receiving 2 or more warfarin "potentiators." Yet interactions between warfarin and other prescription drugs are not the only potential causes of overanticoagulation. Other factors known to alter the response to warfarin include interactions with over-the-counter medications and herbal products, the development of fever or diarrhea, changes in dietary vitamin K intake, underlying comorbid conditions, alcohol intake, and activity level.2 More often than not, however, the specific cause of INR variability is unknown. In a recent study, . . . [Full Text of this Article]
AUTHOR INFORMATION
Ann K. Wittkowsky, PharmD, CACP, FASHP
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International Normalized Ratio Increase Before Warfarin-Associated Hemorrhage: Brief and Subtle
Nils Kucher, Shannon Connolly, Joshua A. Beckman, Lay Har Cheng, Kanella V. Tsilimingras, John Fanikos, and Samuel Z. Goldhaber
Arch Intern Med. 2004;164(19):2176-2179.
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