Analysis of Risk Factors for Bleeding in Patients with Cardiovascular Disease Undergoing Warfarin Treatment at Rsud Kabupaten Tangerang

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Published: Oct 3, 2026
DOI: https://doi.org/10.25077/jsfk.13.02.251-260.2026
Keywords:
Cardiovascular, Herb Use, Hypofibrinogenemia, Risk Factors, Warfarin

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muhamad yqbal
Pancasila University, Faculty of Pharmacy, Master of Pharmaceutical Science, South Jakarta, DKI Jakarta, Indonesia
Dian Ratih
Pancasila University, Faculty of Pharmacy, Master of Pharmaceutical Science, South Jakarta, DKI Jakarta, Indonesia
M. Iqbal Julian R.P.P
Pancasila University, Faculty of Pharmacy, Master of Pharmaceutical Science, South Jakarta, DKI Jakarta, Indonesia
Siti Elkana Nauli
Heart Failure Department, Public Hospital of Tangerang Regency, Tangerang City, Banten, Indonesia

Abstract

Bleeding complications are a major contributor to hospitalization among cardiovascular patients on warfarin therapy, yet the causative factors remain incompletely characterized. This retrospective case-control study aimed to identify significant risk factors and their potential interaction in bleeding incidence among cardiovascular disease (CVD) patients at RSUD Kabupaten Tangerang. Medical-record data from CVD patients on warfarin hospitalized with or without bleeding between January 2023 and December 2024 were analyzed using JAMOVI, encompassing bivariate, multivariate, and interaction analyses. A total of 132 patients were enrolled, comprising 44 (33.3%) cases with bleeding and 88 (66.7%) controls without bleeding. Fisher's exact test, employed due to sparse and unbalanced data, identified significant associations with herb use (p<0.001, OR=460), INR ≥3 (p<0.001, OR=8.33), and hypofibrinogenemia (p<0.001, OR=179). Firth's penalized logistic regression confirmed herb use (aOR=25.33, p<0.001) and hypofibrinogenemia (aOR=19.10, p<0.001) as independently and strongly associated with bleeding, with a strong model fit (Nagelkerke R²=0.854). However, the likelihood ratio test for the synergistic interaction between these two factors was not statistically significant (χ²=2.78, p=0.095). Overall, herb use and hypofibrinogenemia are independently risk factors for bleeding in warfarin-treated cardiovascular patients; the interaction between them was not statistically significant, so clinicians should screen for herb use and monitor fibrinogen levels.

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How to Cite
yqbal, muhamad, Ratih, D., Julian R.P.P, M. I., & Elkana Nauli, S. (2026). Analysis of Risk Factors for Bleeding in Patients with Cardiovascular Disease Undergoing Warfarin Treatment at Rsud Kabupaten Tangerang. Jurnal Sains Farmasi & Klinis, 13(02), 251–260. https://doi.org/10.25077/jsfk.13.02.251-260.2026
Issue
Vol. 13 No. 02 (2026): J Sains Farm Klin 13(2), August 2026
Section
Research Articles
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