Study of target INR achievement, incidence of hemorrhagic complications and affecting factors after during warfarin treatment in western area of China

This study aimed to assess the clinical management of warfarin therapy in Western China by investigating: the rate of international normalized ratio (INR) target achievement and its influencing factors, and the incidence and risk factors for hemorrhagic complications. The primary goal was to identify high-risk patient populations requiring intensified monitoring in this resource-limited region with distinct demographic challenges including multi-ethnic populations and limited healthcare access. We conducted a retrospective cohort analysis of 154 consecutive inpatients prescribed warfarin at a tertiary care center in Western China. Data were systematically collected from: baseline demographics, detailed medication histories, INR monitoring results, and documentation of bleeding events. Statistical analysis employed Pearson chi-square tests to evaluate associations between clinical variables and primary outcomes: achievement of target INR ranges (2.0-3.0 for most indications; 1.8-2.5 for mechanical valves) and development of hemorrhagic complications. Secondary analysis examined factors influencing bleeding severity. The study revealed several critical findings regarding INR control: the overall therapeutic achievement rate was 32.3% for the 2.0-3.0 range (n = 130) and 50.0% for the 1.8-2.5 range (n = 24). Notably, we observed universal therapeutic failure (0% achievement) in three high-risk subgroups: octogenarians (≥ 81 years), underweight patients (BMI < 18.5 kg/m²), and amiodarone users. In contrast, structured physician education demonstrated substantial benefit (72.13% achievement rate vs 27.87% without instruction). Regarding safety outcomes, Bleeding complications were strongly associated with heart failure (16.07% vs 83.93% without), pulmonary infections (20.72% vs 79.28% without), and PPI use (42.86% vs 57.14%). A striking disparity emerged in bleeding severity: cardiothoracic surgery patients experienced minor bleeding at markedly higher rates (66.7%) compared to other departments (≤ 6.7%). This study identifies three high-risk populations in Western China requiring prioritized monitoring: vulnerable patients (advanced age, low BMI), individuals with cardiopulmonary comorbidities, and those prescribed interacting medications (amiodarone, PPIs). These findings have important clinical implications, particularly for resource-limited settings, we propose: implementation of Structured Medication Education Programs, intensive medication monitoring for high-risk patients, development of specialty-specific monitoring protocols in cardiothoracic departments, and establishment of multidisciplinary anticoagulation management teams. These findings underscore the need for context-specific strategies to optimize warfarin therapy in ethnically diverse, under-resourced regions, while highlighting critical areas for future research.