Long-Term Oral Anticoagulant Therapy in Elderly Patients

Wickramasinghe, Lahiru; Basu, Sripurna; Bansal, Sanchit

doi:10.1093/ageing/17.6.388

Cited by 51 publications

(26 citation statements)

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“…9 The relationship between warfarin dose and age, in particular, has long been understood in the context of stable maintenance dose. [22][23][24] The results generated by the current study further our understanding of this relationship by extending it back to the period of warfarin initiation (i.e., prior to determination of the maintenance dose).…”

Section: Discussionmentioning

confidence: 96%

Impact of Age, CYP2C9 Genotype and Concomitant Medication on the Rate of Rise for Prothrombin Time During the First 30 Days of Warfarin Therapy

Wilke¹,

Berg²,

Vidaillet³

et al. 2005

Clinical Medicine & Research

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Objectives:To characterize the impact of several important clinical variables on the rate of anticoagulation during warfarin initiation (i.e., the first 30 days).Design: Retrospective study.Setting: An anticoagulation service of a large horizontally integrated, multispecialty group practice in central and northern Wisconsin. Participants:Patients with sufficient laboratory data obtained during the initiation phase of warfarin treatment. Methods:Patients were consented and genotyped for cytochrome P450 (CYP) 2C9 polymorphisms. Anticoagulation laboratory data were then electronically abstracted and fitted to a logistic growth model. Rate of anticoagulation was compared between groups.Results: During warfarin initiation, the mean slope for rise in International Normalized Ratio (INR) of prothrombin time was significantly associated with age (p=0.03, n=166). Because a relationship between diabetes and warfarin dosing has been suggested previously, we assessed the impact of this comorbidity in our model as well. Diabetes showed relatively little impact, but concomitant treatment with an anti-diabetic sulfonylurea medication was associated with an increase in slope (3-fold, p<0.05).

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Section: Discussionmentioning

confidence: 96%

Impact of Age, CYP2C9 Genotype and Concomitant Medication on the Rate of Rise for Prothrombin Time During the First 30 Days of Warfarin Therapy

Wilke¹,

Berg²,

Vidaillet³

et al. 2005

Clinical Medicine & Research

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“…Com relação à idade, vários autores, como nós, não encontraram relação idade/sangramento 37,[53][54][55] ; entretanto, outros indicam ser um fator independente de sangramento em pacientes tratados com AVK, principalmente com idade superior a 75 anos 47,56,57 . Vários estudos, principalmente em fibrilação atrial, sugerem que, após essa idade, é também mais comum o sangramento intracraniano, quando há aumento de RNI 44,58 .…”

Section: Discussionunclassified

Complicações da terapia anticoagulante com warfarina em pacientes com doença vascular periférica: estudo coorte prospectivo

et al. 2006

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194 ResumoObjetivo: Estudar prospectivamente a freqüência de complicações em pacientes tratados com warfarina e acompanhados no Ambulatório de Anticoagulação da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista.Métodos: Pacientes sorteados entre os agendados para consulta de junho de 2002 a fevereiro de 2004. Na primeira consulta, foi preenchida ficha com dados de identificação e clínicos. A cada retorno, ou quando o paciente procurou o hospital por intercorrência, foi preenchida ficha com a razão normatizada internacional, existência e tipo de intercorrência e condições de uso dos antagonistas da vitamina K.Resultados: Foram acompanhados 136 pacientes (61 homens e 75 mulheres), 99 com tromboembolismo venoso e 37 com doença arterial; 59 pacientes eram de Botucatu, e 77, de outros municípios. Foram registradas 30 intercorrências: nove não relacionadas ao uso da warfarina e 21 complicações hemorrágicas (38,8 por 100 pacientes/ ano). Uma hematêmese foi considerada grave (1,9 por 100 pacientes/ ano). As demais foram consideradas moderadas ou leves. Não houve óbitos, hemorragia intracraniana ou necrose cutânea. A única associação significante foi da freqüência de hemorragia com nível médio de razão normatizada internacional.Conclusão: Nossos resultados mostram a viabilidade desse tratamento em pacientes vasculares em nosso meio, mesmo em população de baixo nível socioeconômico, quando tratados em ambulatório especializado.Palavras-chave: Anticoagulantes, warfarina, efeitos adversos, doenças vasculares, trombose venosa, embolia pulmonar. AbstractObjective: To prospectively study the frequency of complications in patients treated with warfarin followed at Botucatu Medical School.Methods: Patients randomly selected among those with appointments scheduled from June 2002 to February 2004. At the first appointment, a protocol was filled with identification and clinical data. At every return or when the patient went to the hospital due to clinical events, another form was filled with the international normalized ratio, existence and type of clinical event and the conditions of use of vitamin K antagonists.Results: A total of 136 patients (61 men and 75 women), were followed; 99 patients with venous thromboembolism and 37 with arterial disease; 59 were from Botucatu and 77 were from other municipalities. Thirty clinical events were registered: nine of them were not related to the use of warfarin and 21 were hemorrhagic complications (38.8 per 100 patients-year). One hematemesis was considered severe (1.9 per 100 patients-year). The others were considered moderate or mild. There were no deaths, intracranial hemorrhage or cutaneous necrosis. The only significant association was frequency of hemorrhage and average international normalized ratio level.Conclusion: Our results demonstrate the feasibility of this treatment in vascular patients in our country, even in socially and economically poor populations, when treated in specialized clinics.

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“…A history of bleeding has consistently been shown to be predictive of major bleeding associated with antithrombotic therapy [4,5] while the presence of a serious co-morbid condition, such as malignancy, liver or renal insufficiency [6][7][8] also predicts hemorrhagic events. The relationship between older age or pregnancy and anticoagulant-associated bleeding remains controversial [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Management of Patients with Acute Venous Thromboembolism: Findings from the RIETE Registry

Monréal

Suárez²,

Fajardo³

et al. 2003

Pathophysiol Haemos Thromb

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Long-Term Oral Anticoagulant Therapy in Elderly Patients

Cited by 51 publications

References 0 publications

Impact of Age, CYP2C9 Genotype and Concomitant Medication on the Rate of Rise for Prothrombin Time During the First 30 Days of Warfarin Therapy

Impact of Age, CYP2C9 Genotype and Concomitant Medication on the Rate of Rise for Prothrombin Time During the First 30 Days of Warfarin Therapy

Complicações da terapia anticoagulante com warfarina em pacientes com doença vascular periférica: estudo coorte prospectivo

Management of Patients with Acute Venous Thromboembolism: Findings from the RIETE Registry

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