Document Detail

Screening for anemia in patients on warfarin facilitates diagnosis of gastrointestinal malignancies and pre-malignant lesions.
MedLine Citation:
PMID:  22633210     Owner:  NLM     Status:  Publisher    
INTRODUCTION: The prevalence and etiology of occult bleeding among patients on warfarin who are screened systematically for new anemia is largely unknown. We aimed to estimate the usefulness of following hemoglobin and mean red cell volume (MCV) with INR in order to screen for developing anemia as an indicator of occult bleeding. MATERIAL AND METHODS: All patients on warfarin controlled at our institution had measurements of complete blood count (CBC) with INR during 18months. Patients who fell>25g/L and/or decrease of MCV over 5fL or MCV<80fL were contacted with instructions to undergo evaluation of anemia. RESULTS: Overall 3218 patients on warfarin were monitored at our institution and 442 (13.7%) had anemia and 235 (7.3%) had unexplained anemia. A total of 163/235 (69%) who were notified contacted their doctors and 82/163 (50%) were referred for investigation with upper and/or lower endoscopies. Gastrointestinal malignancies were found in 11 patients (10 colorectal cancers, 1 esophageal) and pre-cancerous lesions among 14 other patients. Additional 25/82 patients (30%) had upper and/or lower bleeding lesions such as ulcers and angiodysplasia. Based on 3669years of observation, 73 patients needed to be screened for one year in order to identify one gastrointestinal lesion causing occult bleeding. CONCLUSIONS: Thirty percent of those endoscoped had malignant or pre-malignant diseases. Regular measurement of CBC concomitantly with INR in patients on warfarin therapy led to detection of otherwise asymptomatic diseases in a significant proportion of patients and might lead to earlier diagnosis of malignant and premalignant disease.
Gudrun Arna Johannsdottir; Pall T Onundarson; Brynja R Gudmundsdottir; Einar Stefan Bjornsson
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-5-25
Journal Detail:
Title:  Thrombosis research     Volume:  -     ISSN:  1879-2472     ISO Abbreviation:  -     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-5-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0326377     Medline TA:  Thromb Res     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Ltd.
Department of Internal Medicine, University of Iceland School of Health Sciences, Reykjavik Iceland; Department of Division of Gastroenterology, University of Iceland School of Health Sciences, Reykjavik Iceland.
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