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Elevated international normalized ratio in the ED: clinical course and physician adherence to the published
Ashish Atreja1, Yaser Abu El-Sameed, Hani Jneid
1Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Objective:
Describe the course of patients with an elevated international normalized ratio (INR) in the emergency department (ED) and determine physicians' adherence with treatment recommendations.
Methods:
One-year retrospective review of all ED patients with an INR >5.0.
Results:
Ninety-four patients met the entry criteria. Bleeding was present in 28.7% patients. Two thirds of the major bleeding episodes were of gastrointestinal origin. Physicians' adherence decreased as bleeding and INR increased. At the lowest risk, adherence was 66.6%, whereas at the highest risk, it was 36.3%. Two thirds of patients were admitted to the hospital, one fourth were discharged, and 7.4% were observed in an observation unit. Average length of stay was 3.8 days.
Conclusion:
Adherence to the recommendations regarding managing elevated INR was suboptimal. There is a need for formal endorsement of recommendations by emergency medicine organizations and development of disposition criteria based on bleeding status and site of bleeding.
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