1. Elevated INR in patients on oral anticoagulant therapy: epidemiological, clinical characteristics and outcome. I. Gabranis 1, T. Koufakis 1-2, S. Batala 1, A. Margaritis 1, I. Papakrivos 1, E. Ntava 1, D. Zevgaras 1, G. Papalagara 1, K. Makrigiannis 1, K. Karanikas 1 1 Department of Internal Medicine, General Hospital of Larissa, Larissa, Greece 2 Department of Biomathematics, School of Medicine, University of Thessaly, Larissa, Greece

2. Introduction Excessive anticoagulation is a frequent complication of anticoagulant therapy, associated with high morbidity and mortality rates The risk of hemorrhage approximately doubles for each one point increase in the International Normalized Ratio (INR) above 3.0 Dentali et al. Hematologica 2004 Wilson et al. CMAJ 2004

3. Objectives and Methods To determine the epidemiological and clinical characteristics, as well as, the outcome of patients admitted with prolonged INR due to anticoagulants. 2010-2012 Inclusion criteria: a. INR > 4 b. On oral anticoagulants (acenocoumarol or NOACs) We recorded comorbidities, co-medications and complications observed during hospitalization. Descriptive statistics were used to express patients’ epidemiological data Bad outcome = death Logistic Regression analysis was performed to associate clinical characteristics with bad outcome SPSS, v. 13.0 Kruppa et al. Biom J 2014

4. Results (1) 66 patients (39 males) mean age (± S.D.) 78 years (± 9.08) mean INR value on admission 9.57 (± 4.77) males females 4-10 10-15 > 15

5. Results (2) 95% were on acenocoumarol mean time of hospitalization in days was 4.59 (± 4.53) 28.7 % presented complications with acute renal failure being the most common (12%) acenocoumarol NOACs

6. Results (3) 86.3 % were receiving anticoagulants due to AF 31.8 % : recent initiation of anticoagulant medication (< 30 days) Ecchymosis was the commonest between bleeding complications (30.3 %), followed by LGI bleeding (16.6 %) 31.8 % were in need of blood transfusion, while 84 % of FFP transfusion AF Garcia et al. Thromb Haemost. 2010 Stanworth et al. Crit Care 2011

7. Results (4) 10 deaths (15%) occurred in our cohort Factors associated with bad outcome: occurrence of any type of complications > 5 days of hospitalization hypovolemia on admission parallel use of cephalosporins history of stroke history of pulmonary embolism

8. Conclusions Patients with prolonged INR receiving anticoagulation represent a high-risk group of hospitalized subjects Especially when comorbidities are present Our study proposes some factors which could potentially work as predictors of bad outcome in patients with elevated INR due to oral anticoagulants More and larger studies are required, in order to draw safer conclusions

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