[Oral anticoagulation excess: analysis from an emergency department]

Area of Science:

• Internal Medicine
• Pharmacology
• Geriatrics

Context:

• Anticoagulant therapy, particularly with acenocoumarol, is frequently prescribed for conditions like atrial fibrillation.
• Managing anticoagulation in elderly patients with multiple comorbidities presents unique challenges.
• Emergency departments encounter patients with supratherapeutic International Normalized Ratio (INR) values, necessitating prompt evaluation and management.

Purpose:

• To investigate environmental factors contributing to anticoagulation excess in adult emergency department patients.
• To characterize anticoagulant therapy, comorbidities, concomitant medications, and clinical presentation in patients with excessive anticoagulation.
• To describe the treatment administered to patients experiencing anticoagulation excess.

Summary:

• A prospective study in Madrid's Hospital Gregorio Marañón Emergency Department identified 49 adult patients (mean age 77.9 years) with an INR ≥ 6 due to acenocoumarol use.
• Atrial fibrillation was the primary indication for anticoagulation (71.4%). Common comorbidities included heart failure and chronic nephropathy.
• Active hemorrhage occurred in 34.7% of cases, with recent paracetamol use noted in 24.5%.

Impact:

• Anticoagulation excess is prevalent in individuals over 70, influenced by comorbidities and drug interactions.
• The significant bleeding risk associated with excessive anticoagulation underscores the need for vigilant patient monitoring.
• Findings highlight the importance of comprehensive assessment and management strategies for anticoagulated patients presenting with supratherapeutic INRs.