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Analysis of the clinical application of warfarin and occurrence of bleedingObjective To analyze the situation of bleeding in anticoagulant clinic patients during the course of application of warfarin.Methods The medical record data of the patients who received warfarin in Anticoagulant Clinic of Fuwai Hospital,China Academy ofMedical Sciences from May first,2016 to April 30th,2017 were collected by the hospital outpatient information system and the data were analyzed retroactively.Results A total of 915 patients were enrolled in the study,including 468 males and 447 females with ages from 14 to 89 years and average age of(58±14)years.The number of patients who using warfarin dosage?5 mg/d and 5-9 mg/d was 847 and 69,respectively.There were more patients with postoperative of valve replacement in the youth and the middle age group[87.40%(111/127),73.86%(356/482)]and the patients with auricular fibrillation/atrial flutter in the older age-group[55.88%(171/306)].Of 915 patients,87 cases occurred bleeding events which due to warfarin during the period of medication.The incidence of bleeding was 9.51%.Of 87 patients,7 cases were severe bleeding,the incidence of the severe bleeding was 0.77%.The incidence of bleeding in the older age-group[15.03%(46/306)]was obviously higher than those in the middle age group[7.05%(34/482),P<0.001]and the youth group[5.51%(7/127),P=0.006].The incidence of bleeding in the auricular fibrillation/atrial flutter group[14.76%(40/271)]was obviously higher than that in the postoperative of valve replacement group[6.62%(38/574),P<0.001],The incidence of bleeding in the thromboembolic disease group was 12.86%(9/70).The differences of incidences of bleeding between the thromboembolic disease group and the 2 groups above-mentioned were not statistically significant(all P>0.05).Of 87 patients,75(86.21%)occurred single time bleeding,71(81.61%)occurred single site bleeding,80(91.85%)were slight bleeding.Of 87 patients,82(94.25%)cases5 warfarin dosages were?5 mg/d,77(88.51%)cases9 intermational normalized ratio(INR)were 0.0.Twelve(13.79%)patients combined other drugs during the period of application of warfarin.A total of 113 times of bleeding events occurred in 87 patients.Of 113 times of bleeding,skin mucosal hemorrhage was 31,gingival bleeding 19,hemoirhinia and ocular hemorrhage 13 each,hemoptysis 10,fecal occult blood and/or hemorrhoidal bleeding 7,hemorrhage of digestive tract and urine occult blood 6 each,gross hematuria 5,menstrual extension,colporrhagia,and intracranial hemorrhage 1 time each.Conclusions The incidence of bleeding which due to warfarin in patients of Anticoagulant Clinic in Fuwai Hospital during the course of application of warfarin is 9.51%.The patients with bleeding are mainly elders and the cases whose anticoagulation indication were auricular fibrillation/atrial flutter.The degree of bleeding is mild mainly.Part ? The effect of low molecular weight heparin and fondaparinux on liver foundation:an observational single center studyObjective The aim of this study is to analyze the liver function of pulmonary thromboembolism patients treated with low molecular weight heparin or fondaparinux in the hospital.Methods The medical record data of patients with pulmonary thromboembolism who received low molecular weight heparin(LMWH,including enoxaparin sodium,low molecular weight heparin calcium)or fondaparinux in Fuwai Hospital,China Academy of Medical Sciences from January first,2013 to December 30th,2015 were collected and analyzed retrospectively.The 2015th Roussel Uclaf causality assessment method was used to determine the liver injury associated with the above drugs.Results A total of 463 patients were included in this study,including 221 males and 242 females with ages from 15 to 92 years and the average age of(62±15)years.Of 463 patients,79 cases occurred liver injury due to the above drugs during the treatment,and the incidence was 17.06%.Of 79 patients,75 cases(94.94%)occurred asymptomatic aminotransferase and/or alanine aminotransferase;DILI grade 1 in 77 patients(97.47%),and grade 2 in 2 patients(2.53%);68 cases(86.08%)continued to use the original dose of LMWH or fondaparinux after liver injury;the liver function of 38 cases(48.10%)gradually recovered before discharge-Low molecular weight heparin calcium has the highest risk of liver injuiy,which is 2.4 times as that of enoxaparin sodium[(95%Cl 1.240-4.484),P=0.009];and there is no statistical difference between fondaparinux and enoxaparin sodium[OR 0.345(95%Cl 0.076-1.555),P=0.166],The course of medication for 1-2 weeks and>2weeks had 2.1times[(95%CI 1.219-3.593),P-0.007]and 5.5 times[(95%CI 2.272-13.493),P=0.000]higher risk ofliver injury than that of<lweek,respectively.The risk of liver injury in patients with viral hepatitis also increased by 7.4 times[(95%Cl 1.882-29.216),P=0.004],Conclusions Inpatients were mainly with mild liver injury,and the chief manifestations were asymptomatic elevated serum transaminase levels,which usually recovered spontaneously.The kind of anticoagulation,the course of medication and basic hepatic diseases were risk factors for abnormal liver function. |
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