Bleeding and asymptomatic overdose in patients under Vitamin K antagonist therapy: Frequency and risk factors

Abstract

BackgroundVitamin K antagonists are widely used in the treatment and prevention of thromboembolic disease. However, these drugs can cause serious side effects, especially bleeding. This study aims to evaluate frequency and risk factors of both bleeding and asymptomatic overdose in North African patients undergoing Vitamin K antagonist therapy.MethodsWe performed a cross-sectional study in patients undergoing Vitamin K antagonist therapy. A statistical analysis has been conducted to identify overdose and bleeding risk factors by using chi-square test (p < .05).ResultsOne hundred and eleven patients were included. We recorded 14 cases of bleeding and 26 cases of asymptomatic overdose. Advanced age, poor adherence, concomitant use of paracetamol and history of previous bleeding are significant risk factors of over-anticoagulation. An INR value over 6 at admission, a high therapeutic target range for INR, concomitant use of acetylsalicylic acid, lack of information on overdose signs and measures to be taken in case of bleeding were identified as risk factors for bleeding.ConclusionMost of the risk factors identified in our study seem to be related to patients lack of information and education. These results highlight the importance of creating a therapeutic patient education program.

Evaluation of oral anticoagulants in atrial fibrillation patients over 80 years of age with nonsevere frailty

“…On the other hand, the safety and efficacy of warfarin are dependent on maintaining the INR value within the target range. This finding was supported in previous studies that had shown that inappropriate INR monitoring increases the risk of bleeding events . Indeed, we observed that supratherapeutic INR values and bleeding events were more frequent in patients treated with an inappropriate dose of warfarin rather with an appropriate dose of warfarin.…”

Relationship between the nutritional status and safety and efficacy outcomes in atrial fibrillation patients aged 80 years and over receiving oral anticoagulants

“…In fact, an inappropriate dose adjustment of warfarin tended to be more frequent in outpatients with a CONUT score !5 than in those with a CONUT score <5 in this study [2/3 (66.7%) vs. 9/22 (40.9%)]. It is known that inappropriate INR monitoring increases the risk of bleeding events [22,23]. We inferred that difficulty in regular monitoring may be one possible reason for an increased risk of MB in malnourished patients receiving warfarin.…”

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

“…The global rate of bleeding with the VKA acenocoumarol recorded in this study was comparable to those previously described in some neighbouring and some European countries. [6][7][8] However, this rate was significantly higher than the incidence reported in most Western countries. [9][10][11] This discrepancy in prevalence between countries within a region may be ascribed to differences in socioeconomic status, in management of VKA therapy and differences between experimental and observational studies.…”