Q: 76 years old male with chronic atrial fibrillation (AF) is admitted to ICU with intracranial hemorrhage. Patient is on chronic warfarin treatment for AF. INR is 3.8. INR above 3 predispose patients to the increased risk of bleeding?
A) True
B) False
Answer: A
AF patients on chronic warfarin are recommended to have an INR between 2.0 and 3.0 with an average annual Time in the Therapeutic Range (TTR) >70%. The risk of ischemic stroke increases proportionally as INR values go below 2. Simultaneously, the risk of bleeding increases as INR goes above 3.
Age above 74 years (as our patient in this question) is an independent risk factor for bleeding. Despite this independent risk an INR between 2.0 and 3.0 is recommended in this age group.
#cardiology
References:
1. Fuster V, Rydén LE, Asinger RW, et al. ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology. Circulation 2001; 104:2118.
2. Hylek EM, Go AS, Chang Y, et al. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med 2003; 349:1019.
3. Singer DE, Chang Y, Fang MC, et al. Should patient characteristics influence target anticoagulation intensity for stroke prevention in nonvalvular atrial fibrillation?: the ATRIA study. Circ Cardiovasc Qual Outcomes 2009; 2:297.
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