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Over-anticoagulation by vitamin K antagonists and gender differences.
D Barcellona1, P Schirru2, A Mameli2
1Department of Medical Science and Public Health, University of Cagliari, Italy.
International Journal of Cardiology
|May 9, 2022
Summary
Female patients experience more over-anticoagulation episodes with vitamin K antagonists (VKAs), potentially explaining lower time in therapeutic range (TTR). However, this excess anticoagulation was not linked to increased bleeding events.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Lower time in therapeutic range (TTR) in females on vitamin K antagonists (VKAs) is documented.
- This study investigates over-anticoagulation, gender, VKA type, indications, TTR, and bleeding risk.
Purpose of the Study:
- To evaluate the association between gender and over-anticoagulation in patients on VKAs.
- To determine factors influencing over-anticoagulation episodes and their relationship with TTR and bleeding.
Main Methods:
- Retrospective analysis of 1230 patients with venous thromboembolism or atrial fibrillation from Dec 2000 to Jan 2004.
- Collected data on age, gender, VKA type, indications, INR, bleeding events, and calculated TTR.
Main Results:
- Females had a significantly higher median number of over-anticoagulation episodes per year (0.39) compared to males (0.28).
- Over-anticoagulation episodes were associated with female gender, atrial fibrillation, warfarin, longer follow-up, and TTR <73%.
- No association was found between over-anticoagulation episodes and bleeding events.
Conclusions:
- Higher over-anticoagulation in females may explain their lower TTR.
- Excess anticoagulation did not correlate with increased bleeding risk.
- Acenocoumarol showed better INR recovery than warfarin, suggesting it as a potential alternative for patients with frequent over-anticoagulation.
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