Major Bleeding Events and Associated Factors in a Cohort of Adult Patients Taking Warfarin in an Armed Forces Hospital

Introduction: Warfarin is widely utilized in patients with Atrial Fibrillation (AF) in Malaysia. However, risk of haemorrhage which necessitates monitoring of International Normalised Ratio (INR) and extensive interaction which varies across ethnicity supports the use of Direct Oral Anticoagulants (DOACS). This study is to assess whether demographic data, medical history, and medication history are associated with the risk of major bleeding events. Methodology: Data was collected retrospectively in a case-controlled environment from the Electronic Medical Record (EMR) database. These patients were attending Medical Out-patient Department (MOPD) clinic, Tuanku Mizan Armed Forces Hospital (TMAFH) from 2nd to 31st January 2018. Results: Among 60 AF patients reviewed, 83% had labile INR range and 35% reported to have 1 or more bleeding event. It is found there is significant association (p<0.05) for variables of sex, history of stroke, and NSAID usage with the outcome. Discussion: Majority of patients with major bleeding events are Chinese males. The sample size of the current study is too small to be able to arrive at any conclusive results. Conclusion: Further studies with bigger sample size are needed among Malaysian Chinese male population. MOPD should establish a warfarin Medication Therapy Adherence Clinic (MTAC) to optimise pharmaceutical care.