Related Experiment Videos

[Identification of factors responsible for oral over-anticoagulation in outpatients with heart disease]

Román Freixa1, Pedro Blanch, Montse Ibernón

  • 1Servicio de Cardiología, Hospital Creu Roja, Barcelona, Spain. roman.freixa@consorcicreuroja.es

Revista Espanola De Cardiologia
|January 29, 2003
PubMed

Insights

Excessive anticoagulation in heart disease patients on acenocoumarol occurred in 2% of cases. Predictors include artificial heart valves and poor compliance, leading to increased bleeding risk.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Limited research exists on excessive anticoagulation in heart disease patients.
  • Understanding factors leading to over-anticoagulation is crucial for patient safety.

Purpose of the Study:

  • To determine the incidence of excessive anticoagulation (INR > 5) in outpatients with heart disease treated with acenocoumarol.
  • To identify factors associated with over-anticoagulation and bleeding complications.

Main Methods:

  • Prospective observational study of 512 outpatients on acenocoumarol over 7 months.
  • Comparison of a high-INR group (n=55) with a control group (n=49) within therapeutic range.
  • Multivariate analysis to identify independent predictors of over-anticoagulation.

Main Results:

  • Overall incidence of high-INR (International Normalized Ratio) > 5 was 2% (77/3683 tests).
  • Independent predictors of over-anticoagulation included artificial heart valve, poor compliance, new interacting drugs, and recent illness.
  • Patients with INR > 5 experienced significantly more bleeding episodes (21.8% vs 4.08%, p=0.008), including one major bleed.

Conclusions:

  • The incidence of excessive anticoagulation is comparable to previous studies.
  • Patients with INR > 5 face a higher risk of bleeding complications, mostly minor.
  • Caution is advised for patients with artificial heart valves, poor compliance, on new interacting drugs, or recently ill.
Abstract

Related Concept Videos

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
Coronary Artery Disease IV: Preventive Measures01:26

Coronary Artery Disease IV: Preventive Measures

Effective preventive measures for coronary artery disease (CAD) focus on controlling modifiable risk factors, including cholesterol abnormalities and lifestyle changes.Cholesterol ManagementFirst, the Mediterranean diet and the American Heart Association advocate for maintaining low-density lipoprotein (LDL) cholesterol levels below 100 mg/dL, with a more stringent recommendation of below 70 mg/dL for individuals at high risk. LDL cholesterol, often termed "bad cholesterol," can lead to the...
Venous Thrombosis IV: Nursing Management01:30

Venous Thrombosis IV: Nursing Management

Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
Drug Toxicity: Risk factors01:24

Drug Toxicity: Risk factors

Adverse Drug Reactions (ADRs) are potential complications that arise during pharmacotherapy, influenced by multiple risk factors. Age plays a significant role; both neonates and the elderly are at heightened risk due to their respective immature and diminished metabolic and elimination processes. Gender also impacts ADRs, with females experiencing a 1.5 to 1.7-fold greater risk than males, which may be linked to pharmacokinetic, pharmacodynamic, and hormonal differences. Notably, neonates, the...