Many patients require medication to thin blood, and some of these patients also have liver disease. Often warfarin is prescribed for this condition. This presents a challenge for physicians and patients, as the risk of bleeding in patients with liver disease taking warfarin is unknown and has not been studied.
BUSM Associate Professor of Medicine Adam Rose, MD, who is also affiliated with the VA of Bedford, Mass., Lydia Efird, MD, a former BMC resident (2013) in internal medicine and first author, and others have found that patients with liver disease taking warfarin have more bleeding events, and that certain lab values are most predictive of bleeds. Using these findings, they created a simple predictive scoring tool to assist clinicians. In a retrospective cohort study of more than 100,000 VA patients taking warfarin the researchers identified outcomes in more than 1700 patients with liver disease. Findings include:
- Patients with liver disease taking warfarin have poorer anticoagulation control and more major bleeds.
- Low albumin levels and poor renal function, as measured by creatinine, are most predictive of these poor outcomes.
The researchers created a 4-point clinical predictive tool to help identify and individualize the risks of treatment and direct future interventions. The system uses albumin and creatinine which help predict patients that are at risk of a major bleed while taking warfarin. “Prescribing blood thinners to patients with liver disease is challenging. This simple tool allows a quick calculation, in the office or bedside, to help clinicians predict which patients may safely receive warfarin and in which patients it is best avoided,” said Efird.
This article was published in Circulation Cardiovascular Quality Outcomes, May 20 2014. Epub May 13, 2014, 4 p.m. (Circ Cardiovasc Qual Outcomes. 2014;7:461-467) http://circoutcomes.ahajournals.org/