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Dalmau Llorca MR, Aguilar Martín C, Carrasco-Querol N, Hernández Rojas Z, Rodríguez Cumplido D, Castro Blanco E, Queiroga Gonçalves A, Fernández-Sáez J, Pérez-Villacastín J. Clinical value of a tool for managing oral anticoagulation in nonvalvular atrial fibrillation in primary health care. Randomized clinical trial. Rev Esp Cardiol (Engl Ed) 2023:S1885-5857(23)00335-3. [PMID: 38056770 DOI: 10.1016/j.rec.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES The management of atrial fibrillation is complex and requires improvement at strategic points, such as in the control of patients treated with vitamin K antagonists. The aim of this study was to evaluate the impact on health outcomes of a nonvalvular atrial fibrillation decision support tool based on visualization of the time in therapeutic range in primary care. METHODS The present randomized clinical trial was conducted in 2018 with a 1-year follow-up in 325 primary care centers in Catalonia. In the intervention centers, the decision support tool was installed to control the time in therapeutic range of patients treated with vitamin K antagonists. The tool was not visualized in the control group. This clinical trial was registered with ClinicalTrials.gov (NCT03367325). RESULTS In total, 44 556 patients were studied. The intervention protected against admission for stroke (adjusted odds ratio [OR], 0.70; 95% confidence interval [95%CI], 0.55-0.88). The number needed to treat was 3502 (95%CI, 3305-3725) while the number of admissions for stroke avoided was 12.63 (95%CI, 11.88-13.38). The intervention also protected against mortality (adjusted OR, 0.78; 95%CI, 0.67-0.90), with a number needed to treat of 13 687 (95%CI, 10 789-18 714) and number of deaths avoided of 3.23 (95%CI, 2.36-4.10). CONCLUSIONS The decision support tool was associated with slight reductions in the numbers of admissions for ischemic stroke and mortality. Although the follow-up time was short and the effect of the intervention was small, the results are valuable and could improve implementation of the tool.
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Affiliation(s)
- M Rosa Dalmau Llorca
- Servei Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain; Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain; Programa de Doctorat Biomedicina, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain.
| | - Carina Aguilar Martín
- Servei Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain; Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain; Programa de Doctorat Biomedicina, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain.
| | - Noèlia Carrasco-Querol
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain
| | - Zojaina Hernández Rojas
- Servei Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain; Programa de Doctorat Biomedicina, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain
| | - Dolores Rodríguez Cumplido
- Departament de Farmacologia Clínica, Hospital Universitari Bellvitge, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Elisabet Castro Blanco
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain; Programa de Doctorat Biomedicina, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain
| | - Alessandra Queiroga Gonçalves
- Servei Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain; Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain
| | - José Fernández-Sáez
- Servei Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain; Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, (IDIAPJGol), Tortosa, Tarragona, Spain; Programa de Doctorat Biomedicina, Universitat Rovira i Virgili, Tortosa, Tarragona, Spain
| | - Julián Pérez-Villacastín
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Girón-Ortega JA, Girón-González JA. Direct-acting oral anticoagulants in antiphospholipid syndrome: A systematic review. Med Clin (Barc) 2023:S0025-7753(23)00157-4. [PMID: 37105842 DOI: 10.1016/j.medcli.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023]
Abstract
The objective of the systematic review is to analyze the efficacy of direct-acting oral anticoagulants (DOAC) in the prophylaxis of thrombosis in antiphospholipid syndrome (APS). We searched for clinical trials, cohort studies and meta-analyses published from January 1, 2012 to September 30, 2022. Articles that analyzed the efficacy of DOAC in the prevention of thrombosis recurrence, with or without comparison with antivitamin K (VKA) drugs, were selected. DOACs, specifically rivaroxaban and apixaban, were significantly less effective than VKAs in preventing recurrence of thrombosis in patients with APS and prior arterial thrombosis or the concomitant presence of two or three different antiphospholipid antibodies. The proportion of patients with severe bleeding as side effect are similar in those treated with DOAC and with VKA. The results argue against the use of DOAC in the treatment of patients with thrombotic APS.
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Affiliation(s)
| | - José Antonio Girón-González
- Servicio de Medicina Interna, Hospital Universitario Puerta del Mar, Facultad de Medicina, Universidad de Cádiz, Instituto para la Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, España
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Sánchez-Pujol MJ, Docampo Simón A, Illán Gambín F, Niveiro de Jaime M, Blanes Martínez M. Calciphylaxis: Risk Factors and Histologic Findings in a Case Series From a Tertiary Care Referral Hospital. Actas Dermosifiliogr (Engl Ed) 2021; 112:S0001-7310(21)00164-2. [PMID: 33939992 DOI: 10.1016/j.ad.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 11/29/2022] Open
Abstract
Recent years have seen important advances in our understanding of calciphylaxis, especially regarding newly identified risk factors and histologic findings that may aid diagnosis. This retrospective study of cases of calciphylaxis treated in our hospital in the last 13 years focuses on newly revealed aspects of this disease. We describe 16 patients (62.5% women; mean age, 67.9 years). In addition to advanced kidney disease (in 75% of our patients), other factors associated with the presence of calciphylaxis were a history of treatments related to phosphorus and calcium metabolism (75%) and anticoagulation (62.5%), usually with vitamin-K antagonists. Histology showed alterations in elastic fibers in only 25% of the biopsy specimens. Eleven of the patients died: sepsis was most often the cause.
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Affiliation(s)
- M J Sánchez-Pujol
- Servicio de Dermatología, Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, España.
| | - A Docampo Simón
- Servicio de Dermatología, Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, España
| | - F Illán Gambín
- Servicio de Anatomía Patológica, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, España
| | - M Niveiro de Jaime
- Servicio de Anatomía Patológica, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, España
| | - M Blanes Martínez
- Servicio de Dermatología, Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, España
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Esteban Terradillos S, Erdozain Castiella JG, Goiri Aparicio JM, Ratón Nieto JA, Fernández Larrinoa Santamaria A, Monte Armenteros J. IgA vasculitis induced by acenocoumarol. Reumatol Clin (Engl Ed) 2020; 16:362-363. [PMID: 30031735 DOI: 10.1016/j.reuma.2018.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/06/2018] [Accepted: 05/29/2018] [Indexed: 06/08/2023]
Abstract
We present the case of a 73-year-old man with IgA vasculitis after administration of acenocoumarol, confirmed by anatomopathological study. He had cutaneous, joint and renal involvement. With the reintroduction of the drug, the clinical manifestations worsened. They were completely resolved with its suspension, without additional maintenance treatment.
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Affiliation(s)
- Sara Esteban Terradillos
- Servicio de Dermatología y Venereología, Hospital Universitario Cruces, Barakaldo, Vizcaya, España.
| | | | | | - Juan Antonio Ratón Nieto
- Servicio de Dermatología y Venereología, Hospital Universitario Cruces, Barakaldo, Vizcaya, España
| | | | - Juan Monte Armenteros
- Servicio de Medicina Interna, Hospital Universitario Cruces, Barakaldo, Vizcaya, España
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Mateos Rodríguez JJ, Bellido D, Castro D, Portillo Sánchez J, Vanegas R, Núñez García A. After failure with acenocoumarol, rivaroxaban in antiphospholipid syndrome: A report of 2 cases. Reumatol Clin (Engl Ed) 2019; 15:e33-e35. [PMID: 28546102 DOI: 10.1016/j.reuma.2017.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 06/07/2023]
Abstract
Antiphospholipid syndrome is characterized by abortions or thrombotic phenomena associated with specific antibodies. Anticoagulant therapy is based on vitamin K antagonists. We present two cases in which the use of rivaroxaban achieved control of the disease after the failure of acenocoumarol.
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Affiliation(s)
| | - David Bellido
- Servicio de Medicina Interna, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - David Castro
- Servicio de Reumatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - José Portillo Sánchez
- Servicio de Medicina Interna, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - Raúl Vanegas
- Servicio de Hematología, Hospital General Universitario de Ciudad Real, Ciudad Real, España
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Contreras Muruaga MM, Reig G, Vivancos J, González A, Cardona P, Ramírez-Moreno JM, Martí-Fábregas J, Suárez Fernández C. Factors associated with poor anticoagulation control with vitaminK antagonists among outpatients attended in Internal Medicine and Neurology. The ALADIN study. Rev Clin Esp 2018; 218:327-335. [PMID: 29983190 DOI: 10.1016/j.rce.2018.04.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/24/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To identify factors associated with poor anticoagulation control with vitaminK antagonists (VKA) among outpatients with nonvalvular atrial fibrillation (NVAF) attended in Neurology and Internal Medicine in Spain. METHODS Cross-sectional and multicenter study, from the ALADIN database, of outpatients with NVAF treated with VKA and attended in Internal Medicine and Neurology in Spain. Rates of anticoagulation control were determined with the direct and Rosendaal methods, considering data from the 6months before the inclusion. RESULTS Out of 1,337 patients included in the ALADIN study, 750 were taking VKA, and complete information about INR values in the last 6months was available in 383 patients. Mean scores of Charlson Index, CHADS2, CHA2DS2-VASc and HAS-BLED were 1.94±1.54; 3.10±1.26; 4.63±1.54, and 2.20±0.90, respectively. 46.2% and 47.0% of patients had an adequate anticoagulation control according to the direct and Rosendaal methods, respectively. Inadequate anticoagulation control according to the direct method was associated with diabetes (OR: 2.511; 95%CI: 1.144-5.659), prior labile INR (OR: 35.371; 95%CI: 15.058-83.083) and the determination of >6INR controls in the last 6months (OR: 4.747; 95%CI: 2.094-10.759), and according to the Rosendaal method, with prior labile INR (P<.001) and HAS-BLED score (OR: 3.991; 95%CI: 2.520-6.319). CONCLUSIONS Despite the high thromboembolic risk, only a little more than a half of patients were well controlled. Factors associated with poor anticoagulation control were diabetes, labile INR, >6INR controls and HAS-BLED.
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Affiliation(s)
- M M Contreras Muruaga
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España.
| | - G Reig
- Servicio de Neurología, Hospital Universitario de La Princesa, Madrid, España
| | - J Vivancos
- Servicio de Neurología, Hospital Universitario de La Princesa, Madrid, España
| | - A González
- Servicio de Neurología y Neurofisiología Clínica, Hospital San Roque Las Palmas, Las Palmas, España
| | - P Cardona
- Servicio de Neurología, Hospital Universitario de Bellvitge (HUB), Hospitalet de Llobregat, Barcelona, España
| | - J M Ramírez-Moreno
- Unidad de Ictus, Servicio de Neurología, Departamento de Ciencias Biomédicas, Hospital Universitario Infanta Cristina, Badajoz, España
| | - J Martí-Fábregas
- Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, España
| | - C Suárez Fernández
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
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Precioso Costa FJ, Larré Muñoz MJ, Navarro Ros FM, Silvero YA, Garrido Sepúlveda L, Llisterri Caro JL. [Level of control and treatment adherence of anticoagulation with acenocoumarol in Primary Care]. Semergen 2015; 42:363-9. [PMID: 26602939 DOI: 10.1016/j.semerg.2015.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/06/2015] [Accepted: 08/14/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine the level of control in treatment compliance in a sample of patients who were treated with acenocoumarol attended in Primary Care settings. MATERIAL AND METHODS Cross-sectional study. Patients with non-valvular atrial fibrillation treated with acenocoumarol were included. The sample size was calculated based on previous studies. Data of patients who possessed International Normalized Ratio (INR) values in last 6 months in medical consult were collected. It was considered that the INR control was inadequate when the percentage of INR values within the therapeutic range was less than 60% in the last 6 months. Assessment of compliance by telephone interview was conducted by the Morisky-Green Test. RESULTS One hundred and ninety-one patients, 110 women (57.6%) with an average age of 76.5±9.4 years were included. Seventy-six patients (39.8%) were in therapeutic range (INR: 2-3) and 115 patients (60.2%) were out of range (below 2 the 20.9% and above 3 the 39.3%). Poor control of INR increased to the age of 85 years (<75 years: 57.8%; 75-85 years: 67.6%;>85 years: 61.5%). Ninety patients responded to the compliance questionnaire (78.3%), being compliant 74 (82.2%) and non-compliant 16 (17.8%). CONCLUSIONS Six of 10 patients undergoing treatment with acenocoumarol are out of range and nearly 2 of each 10 patients out of range does not accomplish the treatment. We call attention to the need to make a systematically review of adherence in anticoagulated patients attended in Primary Care settings.
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Affiliation(s)
| | - M J Larré Muñoz
- Centro de Salud Ingeniero Joaquín Benlloch, Valencia, España
| | - F M Navarro Ros
- Centro de Salud Ingeniero Joaquín Benlloch, Valencia, España
| | - Y A Silvero
- Centro de Salud Ingeniero Joaquín Benlloch, Valencia, España
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Barón Esquivias G, Escolar Albaladejo G, Zamorano JL, Betegón Nicolás L, Canal Fontcuberta C, de Salas-Cansado M, Rubio-Rodríguez D, Rubio-Terrés C. Cost-effectiveness Analysis Comparing Apixaban and Acenocoumarol in the Prevention of Stroke in Patients With Nonvalvular Atrial Fibrillation in Spain. ACTA ACUST UNITED AC 2014; 68:680-90. [PMID: 25498373 DOI: 10.1016/j.rec.2014.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Cost-effectiveness analysis of apixaban (5 mg twice daily) vs acenocoumarol (5mg/day) in the prevention of stroke in patients with nonvalvular atrial fibrillation in Spain. METHODS Markov model covering the patient's entire lifespan with 10 health states. Data on the efficacy and safety of the drugs were provided by the ARISTOTLE trial. Warfarin and acenocoumarol were assumed to have therapeutic equivalence. PERSPECTIVES The Spanish National Health System and society. Information on the cost of the drugs, complications, and the management of the disease was obtained from Spanish sources. RESULTS In a cohort of 1000 patients with nonvalvular atrial fibrillation, administration of apixaban rather than acenocoumarol would avoid 18 strokes, 71 hemorrhages (28 intracranial or major), 2 myocardial infarctions, 1 systemic embolism, and 23 related deaths. Apixaban would prolong life (by 0.187 years) and result in more quality-adjusted life years (by 0.194 years) per patient. With apixaban, the incremental costs for the Spanish National Health System and for society would be € 2,488 and € 1,826 per patient, respectively. Consequently, the costs per life year gained would be € 13,305 and € 9,765 and the costs per quality-adjusted life year gained would be € 12,825 and € 9,412 for the Spanish National Health System and for society, respectively. The stability of the baseline case was confirmed by sensitivity analyses. CONCLUSIONS According to this analysis, apixaban may be cost-effective in the prevention of stroke in patients with nonvalvular atrial fibrillation compared with acenocoumarol.
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Affiliation(s)
| | | | - José Luis Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Guillen Astete C, Boteanu A, Medina Quiñones C, Garcia Montes N, Roldan Moll F, Carballo Carmano C, Zea Mendoza A. Is it safe to perform joint infiltrations or aspirations in patients anticoagulated with acenocoumarol? ACTA ACUST UNITED AC 2015; 11:9-11. [PMID: 24891041 DOI: 10.1016/j.reuma.2014.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/19/2014] [Accepted: 03/10/2014] [Indexed: 11/23/2022]
Abstract
The purpose of this study is to determine the rate of bleeding complications in patient's anticoagulated with acenocoumarol according to the international normalized ratio (INR) coagulation index. A cross-sectional study was performed with 901 charts of patients who underwent arthrocentesis or joint infiltration between 2009 and 2013; the charts were grouped on the basis of having an INR higher or lower than 2.0 (268 and 633, respectively). Comparisons were performed in terms of rates of early or late bleeding complications. A 0.37% rate of early bleeding complications (< 24hours) was observed in the group of patients with INR<2 and 0.99% in the group of patients with INR≥2 (P=.47). Only one case of late complication was presented by bleeding between 24 hours and 30 days, in the group of patients with INR≥2. We conclude that oral anticoagulation with acenocoumarol at terapeutical doses does not increase the risk of bleeding joint punctures.
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Nantes Ó, Zozaya JM, Montes R, Hermida J. [Gastrointestinal lesions and characteristics of acute gastrointestinal bleeding in acenocoumarol-treated patients]. Gastroenterol Hepatol 2014; 37:334-41. [PMID: 24582763 DOI: 10.1016/j.gastrohep.2013.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/13/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
Abstract
UNLABELLED In the last few years, the number of anticoagulated patients has significantly increased and, as a consequence, so have hemorrhagic complications due to this therapy. We analyzed gastrointestinal (GI) bleeding because it is the most frequent type of major bleeding in these patients, and we hypothesized that they would have lesions responsible for GI bleeding regardless of the intensity of anticoagulation, although excessively anticoagulated patients would have more serious hemorrhages. OBJECTIVES To study the characteristics of anticoagulated patients with GI bleeding and the relationship between the degree of anticoagulation and a finding of causative lesions and bleeding severity. PATIENTS AND METHODS We prospectively studied 96 patients, all anticoagulated with acenocoumarol and consecutively admitted to hospital between 01/01/2003 and 09/30/2005 because of acute GI bleeding. We excluded patients with severe liver disease, as well as nine patients with incomplete details. RESULTS The incidence of GI bleeding requiring hospitalization was 19.6 cases/100,000 inhabitants-year. In 90% of patients, we found a causative (85% of upper GI bleeding and 50% of lower GI bleeding) or potentially causative lesion, and 30% of them required endoscopic treatment, without differences depending on the intensity of anticoagulation. No relationship was found between the type of lesions observed and the degree of anticoagulation in these patients. Patients who received more intense anticoagulation therapy had more severe hemorrhages (23% of patients with an INR ≥4 had a life-threatening bleed versus only 4% of patients with INR <4). CONCLUSIONS We found an incidence of 20 severe GI bleeding episodes in anticoagulated patients per 100,000 inhabitants-year, with no difference in localization or in the frequency of causative lesions depending on the intensity of anticoagulation. Patients receiving more intense anticoagulation had more severe GI bleeding episodes.
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Affiliation(s)
- Óscar Nantes
- Servicio de Aparato Digestivo-A, Complejo Hospitalario de Navarra, Pamplona, España.
| | - José Manuel Zozaya
- Servicio de Aparato Digestivo-A, Complejo Hospitalario de Navarra, Pamplona, España
| | - Ramón Montes
- Laboratorio de Trombosis y Hemostasia, Área de Ciencias Cardiovasculares, CIMA de la Universidad de Navarra, Pamplona, España
| | - José Hermida
- Laboratorio de Trombosis y Hemostasia, Área de Ciencias Cardiovasculares, CIMA de la Universidad de Navarra, Pamplona, España
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