Exploring The Association Between Risk Of Bleeding And Comorbid Conditions For Patients With Warfarin Treatment

OBJECTIVES: Warfarin is widely used in Saudi Arabia. Because risk of bleeding is one of the main concerns associated with the use of warfarin, regular warfarin monitoring is an essential part of ensuring that the international normalized ratio for all patients falls within the narrow therapeutic range. Accordingly, this study sought mainly to explore the association between risk of bleeding and diagnosis of different comor-bid conditions in patients using warfarin. METHODS: This cross-sectional study was conducted at King Abdulaziz Medical City (KAMC) among a sample of patients who were diagnosed with atrial fibrillation and on warfarin treatment between March and April 2014, during ambulatory care visits. With the approval of the King Abdullah International Medical Research Center's Institutional Review Board, a series of descriptive and inferential statistical analyses was conducted comparing patients with and without incidence of bleeding. The R Studio integrated development environment was used to perform statistical analyses such as chi-squared testing and logistic regression. RESULTS: A total of 264 patients were eligible and included in the study. About 55% of the patients were females and the majority were 65 years and older. The highest prevalent disease was hypertension (79.5%) followed by diabetes mellitus (54.5%). It was estimated that patients with diabetes were 73% less likely to have major bleeding, compared to patients without diabetes. Also, patients with abnormal renal function were about three times more likely to have major bleeding. Regarding minor bleeding, females and hypertensive patients were more likely to have minor bleeding than others. CONCLUSIONS: Careful evaluation of the type of each patient's comorbid condition could aid prediction of which patients have a high risk of both major and minor bleeding, thereby helping prevent major bleeding incidents.