Can Asymptomatic Patients With a Supratherapeutic International Normalized Ratio Be Safely Treated as Outpatients?

[Ann Emerg Med. 2012;59:318-320.] To determine whether asymptomatic patients with a supratherapeutic international normalized ratio (INR) warrant admission, a MEDLINE and EMBASE search was performed with the terms "warfarin AND anticoagulation," "warfarin AND bleeding," "warfarin and complications," and "warfarin and INR." The references in relevant articles were also searched. A secondary objective was to determine the risk of hemorrhage within 1 week. No randomized trials comparing inpatient versus outpatient management of asymptomatic patients with an increased INR were identified. Several studies examining outcomes after outpatient management, however, were identified. According to this review, it is certainly within the standard of care to manage patients with an asymptomatic, supratherapeutic INR as outpatients.