J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 11, Number 2, February 2019, pages 106-113

Bleeding Complications in Warfarin-Treated Patients Admitted to the Emergency Department

**Table 1.** Distribution of Presenting Complaints of the Study Patients
Complaint*	n (%)
*Patients may have presented with more than one complaint; analyses were performed for 141 admissions among 96 patients.
Fatigue	86 (61.0)
Shortness of breath	39 (27.7)
Extremity pain	38 (27.0)
Vomiting	17 (12.1)
Bloody urine	15 (10.6)
Ecchymosis	13 (9.2)
Abdominal pain	13 (9.2)
Fever	11 (7.8)
Diarrhea and vomiting	11 (7.8)
Headache	10 (7.1)
Dizziness	10 (7.1)
Weakness	10 (7.1)
Chest pain	9 (6.4)
Palpitation	8 (5.7)
Faint	7 (5.0)
Speech disorder	5 (3.5)
Nasal bleeding	4 (2.8)
Contraction	4 (2.8)

Table 1. Distribution of Presenting Complaints of the Study Patients

Complaint*

n (%)

*Patients may have presented with more than one complaint; analyses were performed for 141 admissions among 96 patients.

Fatigue

86 (61.0)

Shortness of breath

39 (27.7)

Extremity pain

38 (27.0)

Vomiting

17 (12.1)

Bloody urine

15 (10.6)

Ecchymosis

13 (9.2)

Abdominal pain

13 (9.2)

Fever

11 (7.8)

Diarrhea and vomiting

11 (7.8)

Headache

10 (7.1)

Dizziness

10 (7.1)

Weakness

10 (7.1)

Chest pain

9 (6.4)

Palpitation

8 (5.7)

Faint

7 (5.0)

Speech disorder

5 (3.5)

Nasal bleeding

4 (2.8)

Contraction

4 (2.8)

**Table 2.** Frequency of Major and Minor Bleeding and the Bleeding Sites According to the Number of Admissions and Patients
	Major bleeding	Minor bleeding
Bleeding may have occurred at more than one site and may have differed in type.
Bleeding site
Subcutaneous hematoma, ecchymosis			10 (10.4)	13 (9.2)
Hematuria	10 (10.4)	12 (8.5)
Nasal bleeding			4 (4.2)	4 (2.8)
Hemoptysis			2 (2.1)	3 (2.1)
Lower gastrointestinal bleeding	2 (2.1)	2 (1.4)
Intramuscular or intra-abdominal hematoma	2 (2.1)	2 (1.4)
Intracranial hemorrhage	2 (2.1)	2 (1.4)
Vaginal bleeding			2 (2.1)	2 (1.4)
Retinal hemorrhage			1 (1.0)	1 (0.7)
Upper gastrointestinal bleeding	1 (1.0)	1 (0.7)
Total	17 (17.7)	19 (13.5)	19 (19.8)	23 (16.3)

Table 2. Frequency of Major and Minor Bleeding and the Bleeding Sites According to the Number of Admissions and Patients

Major bleeding

Minor bleeding

Patients (n = 96)

Admissions (n = 141)

Patients (n = 96)

Admissions (n = 141)

n (%)

Bleeding may have occurred at more than one site and may have differed in type.

Bleeding site

Subcutaneous hematoma, ecchymosis

10 (10.4)

13 (9.2)

Hematuria

10 (10.4)

12 (8.5)

Nasal bleeding

4 (4.2)

4 (2.8)

Hemoptysis

2 (2.1)

3 (2.1)

Lower gastrointestinal bleeding

2 (2.1)

2 (1.4)

Intramuscular or intra-abdominal hematoma

2 (2.1)

2 (1.4)

Intracranial hemorrhage

2 (2.1)

2 (1.4)

Vaginal bleeding

2 (2.1)

2 (1.4)

Retinal hemorrhage

1 (1.0)

1 (0.7)

Upper gastrointestinal bleeding

1 (1.0)

1 (0.7)

Total

17 (17.7)

19 (13.5)

19 (19.8)

23 (16.3)

**Table 3.** Characteristics of the Patients According to the Presence of Bleeding Complications
	Bleeding	P
Age, year
< 65	11 (34.4)	31 (48.4)	0.190
≥ 65	21 (65.6)	33 (51.6)
Sex
Male	18 (56.2)	28 (43.8)	0.248
Female	14 (43.8)	36 (56.2)
Reasons for warfarin therapy
Atrial fibrillation	18 (56.3)	39 (60.9)	0.659
Stroke	6 (18.8)	10 (15.6)	0.699
Cardiac valve prosthesis	3 (9.4)	6 (9.4)	1.000
Antithrombin III deficiency	3 (9.4)	2 (3.1)	-
Pulmonary embolism	2 (6.3)	3 (4.7)	-
Peripheral artery disease	1 (3.1)	3 (4.7)	-
Deep vein thrombosis	1 (3.1)	1 (1.6)	-
Duration of warfarin use
≤ 1 year	5 (15.6)	7 (10.9)	0.527
> 1 year	27 (84.4)	57 (89.1)

Table 3. Characteristics of the Patients According to the Presence of Bleeding Complications

Bleeding

Present (n = 32)

Absent (n = 64)

n (%)

Age, year

< 65

11 (34.4)

31 (48.4)

0.190

≥ 65

21 (65.6)

33 (51.6)

Sex

Male

18 (56.2)

28 (43.8)

0.248

Female

14 (43.8)

36 (56.2)

Reasons for warfarin therapy

Atrial fibrillation

18 (56.3)

39 (60.9)

0.659

Stroke

6 (18.8)

10 (15.6)

0.699

Cardiac valve prosthesis

3 (9.4)

6 (9.4)

1.000

Antithrombin III deficiency

3 (9.4)

2 (3.1)

Pulmonary embolism

2 (6.3)

3 (4.7)

Peripheral artery disease

1 (3.1)

3 (4.7)

Deep vein thrombosis

1 (3.1)

1 (1.6)

Duration of warfarin use

≤ 1 year

5 (15.6)

7 (10.9)

0.527

> 1 year

27 (84.4)

57 (89.1)

**Table 4.** Comorbidities and Concurrent Medications in Patients With and Without Bleeding
	Bleeding	P
Comorbidity
Hypertension	26 (81.3)	46 (71.9)	0.317
Heart disease	15 (46.9)	32 (50.0)	0.773
Diabetes	11 (34.4)	18 (28.1)	0.530
Chronic obstructive pulmonary disease	3 (9.4)	10 (15.6)	0.534
Cerebrovascular disease	2 (6.3)	9 (14.1)	0.327
Chronic kidney insufficiency	1 (3.1)	7 (10.9)	0.262
Chronic liver disease	0 (0)	1 (1.6)	-
Malignancy	1 (3.1)	0 (0)	-
Concurrent medication
Antidepressants	5 (15.6)	12 (18.8)	0.705
Acetylsalicylic acid	5 (15.6)	7 (10.9)	0.513
Allopurinol	3 (9.4)	7 (10.9)	1.000
Metformin	6 (18.8)	4 (6.3)	0.079
Lipid-lowering drugs	5 (15.6)	4 (6.3)	0.155
Antibiotic	4 (12.5)	4 (6.3)	0.434
Levothyroxine	4 (12.5)	2 (3.1)	0.093
Antiepileptic	2 (6.3)	4 (6.3)	1.000
Non-steroidal anti-inflammatory drugs	1 (3.1)	2 (3.1)	-
Low molecular-weight heparin	1 (3.1)	1 (1.6)	-
Clopidogrel	0 (0)	2 (3.1)	-

Table 4. Comorbidities and Concurrent Medications in Patients With and Without Bleeding

Bleeding

Present (n = 32)

Absent (n = 64)

n (%)

Comorbidity

Hypertension

26 (81.3)

46 (71.9)

0.317

Heart disease

15 (46.9)

32 (50.0)

0.773

Diabetes

11 (34.4)

18 (28.1)

0.530

Chronic obstructive pulmonary disease

3 (9.4)

10 (15.6)

0.534

Cerebrovascular disease

2 (6.3)

9 (14.1)

0.327

Chronic kidney insufficiency

1 (3.1)

7 (10.9)

0.262

Chronic liver disease

0 (0)

1 (1.6)

Malignancy

1 (3.1)

0 (0)

Concurrent medication

Antidepressants

5 (15.6)

12 (18.8)

0.705

Acetylsalicylic acid

5 (15.6)

7 (10.9)

0.513

Allopurinol

3 (9.4)

7 (10.9)

1.000

Metformin

6 (18.8)

4 (6.3)

0.079

Lipid-lowering drugs

5 (15.6)

4 (6.3)

0.155

Antibiotic

4 (12.5)

4 (6.3)

0.434

Levothyroxine

4 (12.5)

2 (3.1)

0.093

Antiepileptic

2 (6.3)

4 (6.3)

1.000

Non-steroidal anti-inflammatory drugs

1 (3.1)

2 (3.1)

Low molecular-weight heparin

1 (3.1)

1 (1.6)

Clopidogrel

0 (0)

2 (3.1)

**Table 5.** Distribution of Emergency Department Admissions of Patients With and Without Bleeding According to Season, and Weekly Warfarin Dose
	Bleeding	P
^#Only one patient was taking warfarin > 50 mg/week and was not included in the analyses.
Presenting season
Spring	10 (25.6)	29 (28.4)	0.469
Summer	11 (28.2)	26 (25.5)
Autumn	5 (12.8)	23 (22.5)
Winter	13 (33.3)	24 (23.5)
Warfarin dose, mg/week
< 35	31 (79.5)	90 (88.2)	0.306^#
35 - 50	7 (17.9)	12 (11.8)
> 50	1 (2.6)	0 (0.0)

Table 5. Distribution of Emergency Department Admissions of Patients With and Without Bleeding According to Season, and Weekly Warfarin Dose

Bleeding

Present (n = 39)

Absent (n = 102)

n (%)

^#Only one patient was taking warfarin > 50 mg/week and was not included in the analyses.

Presenting season

Spring

10 (25.6)

29 (28.4)

0.469

Summer

11 (28.2)

26 (25.5)

Autumn

5 (12.8)

23 (22.5)

Winter

13 (33.3)

24 (23.5)

Warfarin dose, mg/week

< 35

31 (79.5)

90 (88.2)

0.306^#

35 - 50

7 (17.9)

12 (11.8)

> 50

1 (2.6)

0 (0.0)

**Table 6.** Distribution of International Normalized Ratio (INR) Values in Major Bleeding, Minor Bleeding and Non-Bleeding Groups of the Study Patients
INR*	Non-bleeding n (%)	Bleeding	P
*Patients had been admitted once, twice, or more than three times; analyses were performed for 141 admissions among 96 patients. Data are presented as percentages (%) or n = numbers of patients.
3 - 4.9	75 (73.5)	11 (10.7)	16 (15.6)	0.492
5 - 8.9	18 (56.3)	1 (3.1)	13 (37.5)	0.342
≥ 9	6 (85.7)	1 (22.3)	0	-

Table 6. Distribution of International Normalized Ratio (INR) Values in Major Bleeding, Minor Bleeding and Non-Bleeding Groups of the Study Patients

INR*

Non-bleeding n (%)

Bleeding

Major bleeding n (%)

Minor bleeding n (%)

*Patients had been admitted once, twice, or more than three times; analyses were performed for 141 admissions among 96 patients. Data are presented as percentages (%) or n = numbers of patients.

3 - 4.9

75 (73.5)

11 (10.7)

16 (15.6)

0.492

5 - 8.9

18 (56.3)

1 (3.1)

13 (37.5)

0.342

≥ 9

6 (85.7)

1 (22.3)

**Table 7.** Comparison of Patients With Major Bleeding and Minor Bleeding According to Age, Gender, Presenting Season and Duration of Warfarin Use
	Bleeding	P
Data are presented as percentages (%) or n = numbers of patients.
Age, year
<65	5 (38.5)	8 (61.5)	< 0.001
≥ 65	10 (34.5)	19 (65.5)
Sex
Male	9 (36)	16 (64)	0.326
Female	5 (29.4)	12 (70.6)
Presenting season
Spring	2 (15.4)	11 (84.6)
Summer	4 (36.4)	7 (63.6)	0.372
Autumn	3 (50)	3 (50)
Winter	5 (41.7)	7 (58.3)
Duration of warfarin use
≤ 1 year	1 (20)	4 (80)	0.027
> 1 year	12 (32.4)	25 (67.6)

Table 7. Comparison of Patients With Major Bleeding and Minor Bleeding According to Age, Gender, Presenting Season and Duration of Warfarin Use

Bleeding

Major (n = 32)

Minor (n = 64)

n (%)

Data are presented as percentages (%) or n = numbers of patients.

Age, year

<65

5 (38.5)

8 (61.5)

< 0.001

≥ 65

10 (34.5)

19 (65.5)

Sex

Male

9 (36)

16 (64)

0.326

Female

5 (29.4)

12 (70.6)

Presenting season

Spring

2 (15.4)

11 (84.6)

Summer

4 (36.4)

7 (63.6)

0.372

Autumn

3 (50)

Winter

5 (41.7)

7 (58.3)

Duration of warfarin use

≤ 1 year

1 (20)

4 (80)

0.027

> 1 year

12 (32.4)

25 (67.6)