Anticoagulation Quality and Complications of using Vitamin K Antagonists in the Cardiac Surgery Outpatient Clinic

Abstract

INTRODUCTION:In patients with mechanical prosthetic heart valves or atrial fibrillation requiring anticoagulation to prevent thromboembolic events, several factors influence adherence and anticoagulation complications.OBJECTIVE:To evaluate the factors that interfere with the quality and complications of anticoagulation with vitamin K antagonists.METHODS:A retrospective cohort study of 100 patients, in the period from 2011 to 2014, was performed. Anticoagulation conditions in the last year, regarding the presence of complications (embolisms/bleeding) and inadequate treatment were assessed: achievement of less than 8 annual prothrombin times and International Normalized Ratio outside therapeutic target in more than 40% of prothrombin times.RESULTS:There were 31 complications (22 minor bleeding without hospitalization and 9 major complications: 7 bleeding with hospitalization and two emboli); 70 were with International Normalized Ratio outside the target in more than 40% of the tests and 36 with insufficient number of prothrombin times. Socioeconomic factors, anticoagulant type and anticoagulation reason had no relationship with complications or with inadequate treatment. There were more complications in patients with longer duration of anticoagulation (P=0.001). Women had more International Normalized Ratio outside the target range (OR 2.61, CI:1.0-6.5; P=0.04). Patients with lower number of annual prothrombin times had longer times of anticoagulation (P=0.03), less annual consultations (P=0.02) and less dose adjustments (P=0.003). Patients with longer duration of anticoagulation have more complications (P=0.001).CONCLUSION:There was a high rate of major complications and International Normalized Ratio was outside the goal. Less annual prothrombin times was related to longer duration of anticoagulation, less annual consultations and less dose adjustments. More major complications occurred in patients with longer duration of anticoagulation.

Frequency of bleeding complications in Algerian patients treated with the vitamin K antagonist acenocoumarol and associated factors

“…They found a greater predisposition for bleeding in the patients with longer courses of treatment. 24,25 It, therefore, appears that overdose is an important factor in terms of bleeding related to VKA. An international normalized ratio (INR) ≥of 4.0 was associated with an increased risk of an accident hemorrhagic.…”

Kalp Kapak Protezleri Sonrası Antikoagülan Tedaviye Uyum

“…Ameliyat sonrası tromboembolik komplikasyonlar sıklıkla ameliyattan sonraki ilk üç ayda görülmektedir. [13,14,15] Uzun dönem komplikasyonların incelendiği çalışmalar, komplikasyon yönetimine yönelik izlem ve takibin önemini göstermektedir. Mekanik kalp kapak protezi takılan hastalarla yapılan retrospektif (2006-2011) bir çalışmada varfarin kullanan 18.022 hasta çalışmaya dahil edilmiştir.…”