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Risks factors for highly unstable response to oral anticoagulation: a case-control study
Gualtiero Palareti1, Cristina Legnani, Giuliana Guazzaloca
1Dipartimento di Angiologia e Malattie della Coagulazione 'Marino Golinelli', Policlinico S. Orsola-Malpighi, Università di Bologna, Bologna, Italy. palareti@tin.it
British Journal of Haematology
|April 2, 2005
Summary
Persistent instability in oral anticoagulant treatment (OAT) is linked to factors like poor patient comprehension and specific CYP2C9 gene variants. Improving understanding of OAT is crucial for stable treatment outcomes.
Area of Science:
- Pharmacology
- Clinical Medicine
- Genetics
Background:
- Oral anticoagulant treatment (OAT) requires careful management to maintain therapeutic International Normalized Ratio (INR) levels.
- Persistent instability in OAT poses risks and necessitates investigation into contributing factors.
Purpose of the Study:
- To identify factors associated with persistent instability in oral anticoagulant treatment (OAT).
- To compare characteristics of patients with unstable OAT versus stable controls.
Main Methods:
- A case-control study involving patients from 35 Italian anticoagulation clinics.
- Data collected included socio-demographics, medical history, lifestyle, CYP2C9 variants, and cognitive/comprehension assessments (Abbreviated Mental Test, OAT questionnaire).
Main Results:
- Higher INR > 4.5 observed in unstable cases (12.3%) vs. stable controls (0.4%).
- Increased odds of instability linked to working status, acenocoumarol use, and insufficient scores on cognitive/comprehension tests.
- Specific CYP2C9 variants (*1/*3, *2/*3, *3/*3) were more frequent in unstable patients (29.9% vs. 15.0%).
Conclusions:
- High intra-individual variability in OAT control is multifactorial.
- Poor patient comprehension of OAT indications and mechanisms is a prevalent factor contributing to treatment instability.