Document Detail

Effect of heart failure exacerbations on anticoagulation: a prospective, observational, pilot cohort study.
MedLine Citation:
PMID:  20399987     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Some studies have suggested that heart failure (HF) is associated with excessive anticoagulation, but definitive data or data showing causation do not exist. Knowledge of risk factors for excessive anticoagulation is critical to manage warfarin therapy safely. OBJECTIVE: This study characterized the relation between HF-associated hypervolemia and excessive anticoagulation in patients with HF taking chronic warfarin therapy. METHODS: This was a prospective, observational pilot study conducted in a university-based HF clinic. Patients aged 18 to 85 years with HF and taking warfarin were enrolled and were observed for episodes of hypervolemia. Hypervolemia was determined based on multiple clinical factors, including patient-reported symptoms and physical examination. Anticoagulation was assessed longitudinally per standard of care by measurement of the international normalized ratio (INR). A chi(2) analysis was used to determine whether hypervolemia was associated with an increased risk of excessive anticoagulation. Paired and unpaired t tests were used for ad hoc analyses. RESULTS: Forty patients with 41 HF episodes who were taking warfarin were enrolled between December 2003 and July 2007. Mean (SD) age was 67.2 (11.1) years and mean weight was 218.5 (62.8) pounds; 29 patients (72.5%) were men and 34 (85.0%) were white. Most had systolic dysfunction (n = 26; 65.0%) and were taking warfarin for atrial fibrillation (n = 33; 82.5%); the mean weekly warfarin dose was 30.8 (17.5) mg. There were 41 evaluable hypervolemia episodes over a mean follow-up of 14.5 (9.0) months. The mean INR change during hypervolemia was -0.02 (0.82) INR unit (P = NS vs baseline). No association was found between hypervolemia episodes and INR increases of > or =50% (P = NS); the results remained nonsignificant for both diastolic and systolic HF when analyzed separately. There was no significant change from baseline INR between patients classified with mild, moderate, or severe hypervolemia or between patients classified according to New York Heart Association (NYHA) functional class (all, P = NS). Patients with NYHA class III had a lower weekly warfarin dose than those with NYHA class II (25.73 vs 31.75 mg; P < 0.01). CONCLUSION: Mild hypervolemia did not appear to be related to excessive anticoagulation in these patients with HF taking chronic warfarin therapy.
Toni L Ripley; Donald Harrison; Robin E Germany; Philip B Adamson
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical therapeutics     Volume:  32     ISSN:  1879-114X     ISO Abbreviation:  Clin Ther     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-04-19     Completed Date:  2010-07-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7706726     Medline TA:  Clin Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  506-14     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Excerpta Medica Inc. All rights reserved.
Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma 73126, USA.
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MeSH Terms
Aged, 80 and over
Anticoagulants / administration & dosage,  adverse effects*,  therapeutic use
Atrial Fibrillation / drug therapy
Blood Volume*
Cohort Studies
Dose-Response Relationship, Drug
Follow-Up Studies
Heart Failure / complications*
International Normalized Ratio
Longitudinal Studies
Middle Aged
Pilot Projects
Prospective Studies
Risk Factors
Severity of Illness Index
Warfarin / administration & dosage,  adverse effects*,  therapeutic use
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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