Bleeding in outpatients treated with warfarin: relation to the prothrombin time and important remediable lesions

Landefeld, C. Seth; Rosenblatt, Miriam W.; Goldman, Lee

doi:10.1016/s0002-9343(89)80690-4

Cited by 195 publications

(63 citation statements)

References 19 publications

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“…By comparison, the present study included a population in which only 3% of index INR values were Ͼ10, the mean index INR was 6.5, the mean age was 69, and only 6% of patients had been taking warfarin for Ͻ3 months. International normalized ratio, age, and the early phase of therapy have all been shown to be risk factors for major hemorrhage among patients taking warfarin (15)(16)(17)(18)(19); INR prolongation conveys the highest risk. During 14 days of follow-up in a previous study by Hylek et al (5), there were no major hemorrhagic events among 268 patients whose INR was in the target range.…”

Section: Discussionmentioning

confidence: 99%

The Risk of Hemorrhage Among Patients With Warfarin-Associated Coagulopathy

García

Regan

Crowther

et al. 2006

Journal of the American College of Cardiology

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Section: Discussionmentioning

confidence: 99%

The Risk of Hemorrhage Among Patients With Warfarin-Associated Coagulopathy

García

Regan

Crowther

et al. 2006

Journal of the American College of Cardiology

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“…The risk of complications is highest during the first 3 months after commencing OAT [2,4,94]. Therefore, if PSM should provide a better quality of treatment, it has been advocated that it should be started immediately/simultaneously after commencement of OAT [2], but this has been done in only three studies [2,31,43].…”

Section: Patient Factors Affecting the Quality Of The Oatmentioning

confidence: 99%

Self-Management of Oral Anticoagulant Therapy: A Review

Christensen

2004

J Thromb Thrombolysis

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Patient self-management of oral anticoagulant therapy has over the last years gained increasing attention and widespread use. The method implies self-testing using a coagulometer (point-of-care device) and self-dosaging of coumarin. The method entails advantages for selected patients, who do not need to go to the hospital or family doctor for blood specimen and drug dosage adjustment. In contrast to patients on conventional management, patients performing self-managing have a reduced binding to the health care system, and it allows these patients unhindered to travel and manage their job or school. Therefore, the patients have a high degree of compliance because they are highly motivated. This has been the main justification for patient self-management. Furthermore, the conducted trials have also indicated a better quality of treatment compared to conventional management. In this paper the different aspects of this new treatment modality are critically reviewed, with special focus on the published clinical studies and the evaluation of the used coagulometers.

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“… Extracted data on reported annual rates of warfarin-associated ICH from major randomized controlled trials (RCTs; Atrial-Fibrillation-Investigators, 1994; SPAF-Investigators, 1994; Olsson, 2003; Albers et al, 2005; DiMarco et al, 2005; Connolly et al, 2006, 2009; Diener et al, 2010; Granger et al, 2011; Patel et al, 2011) of atrial fibrillation compared to non-inception cohort (Fihn et al, 1993; van der Meer et al, 1993; Go et al, 2003; Poli et al, 2009) and inception cohort studies (Landefeld and Goldman, 1989; Steffensen et al, 1997; Beyth et al, 1998; Hylek et al, 2007) . *Subgroup analysis of patients with a previous history of ischemic stroke or transient ischemic attack in the RE-LY trial.…”

Section: Atrial Fibrillation Oral Anticoagulation and Anticoagulatimentioning

confidence: 99%

“…The reported annual rates of warfarin-associated ICH from major RCTs of AF (Atrial-Fibrillation-Investigators, 1994; SPAF-Investigators, 1994; Olsson, 2003; Albers et al, 2005; DiMarco et al, 2005; Connolly et al, 2006, 2009; Diener et al, 2010; Granger et al, 2011; Patel et al, 2011) are systematically lower compared to the rates of ICH of non-inception and inception observational studies (Landefeld and Goldman, 1989; Fihn et al, 1993; van der Meer et al, 1993; Steffensen et al, 1997; Beyth et al, 1998; Go et al, 2003; Hylek et al, 2007; Poli et al, 2009; Figure 2). A recent observational inception cohort study of patients treated with oral anticoagulation (of whom a quarter had a previous history of stroke) reported a 2.5% (95% CI 1.1–4.7%) risk of ICH at 1 year (Hylek et al, 2007).…”

Section: Atrial Fibrillation Oral Anticoagulation and Anticoagulatimentioning

confidence: 99%

Cerebral Microbleeds on Magnetic Resonance Imaging and Anticoagulant-Associated Intracerebral Hemorrhage Risk

Charidimou¹,

Shakeshaft²,

Werring³

2012

Front. Neur.

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The increasing use of antithrombotic drugs in an aging population [including anticoagulants to prevent future ischemic stroke in individuals with atrial fibrillation (AF)] has been associated with a dramatic increase in the incidence of intracerebral hemorrhage (ICH) in users of antithrombotic drugs. Several lines of evidence suggest that cerebral small vessel disease (particularly sporadic cerebral amyloid angiopathy) is a risk factor for this rare but devastating complication of these commonly used treatments. Cerebral microbleeds (CMBs) have emerged as a key MRI marker of small vessel disease and a potentially powerful marker of future ICH risk, but adequately powered, high quality prospective studies of CMBs and ICH risk on anticoagulation are not available. Further data are urgently needed to determine how neuroimaging and other biomarkers may contribute to individualized risk prediction to make anticoagulation as safe and effective as possible. In this review we discuss the available evidence on cerebral small vessel disease and CMBs in the context of antithrombotic treatments, especially regarding their role as a predictor of future ICH risk after ischemic stroke, where risk-benefit judgments can be a major challenge for physicians. We will focus on patients with AF because these are frequently treated with anticoagulation. We briefly describe the rationale and design of a new prospective observational inception cohort study (Clinical Relevance of Microbleeds in Stroke; CROMIS-2) which investigates the value of MRI markers of small vessel disease (including CMBs) and genetic factors in assessing the risk of oral anticoagulation-associated ICH.

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Bleeding in outpatients treated with warfarin: relation to the prothrombin time and important remediable lesions

Cited by 195 publications

References 19 publications

The Risk of Hemorrhage Among Patients With Warfarin-Associated Coagulopathy

The Risk of Hemorrhage Among Patients With Warfarin-Associated Coagulopathy

Self-Management of Oral Anticoagulant Therapy: A Review

Cerebral Microbleeds on Magnetic Resonance Imaging and Anticoagulant-Associated Intracerebral Hemorrhage Risk

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