Elevated international normalized ratio in the ED: Clinical course and physician adherence to the published recommendations

Ashish Atreja, Yaser Abu El-Sameed, Hani Jneid, Byron J. Hoogwerf, William Frank Peacock

Research output: Contribution to journalArticlepeer-review

Abstract

Describe the course of patients with an elevated international normalized ratio (INR) in the emergency department (ED) and determine physicians' adherence with treatment recommendations. One-year retrospective review of all ED patients with an INR >5.0. 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. 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.

Original languageEnglish (US)
Pages (from-to)40-44
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume23
Issue number1
DOIs
StatePublished - Jan 2005
Externally publishedYes

ASJC Scopus subject areas

  • Emergency Medicine

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