Document Detail


Guideline-discordant periprocedural interruptions in warfarin therapy.
MedLine Citation:
PMID:  21304096     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Periprocedural interruptions in warfarin therapy increase thromboembolic risks to patients and are not indicated for all procedures. We sought to determine the frequency and guideline concordance of periprocedural warfarin interruptions to inform a future educational intervention.
METHODS AND RESULTS: In October and November of 2009, an anonymous postal survey was sent to all patients followed for more than 1 year by the University of Michigan Anticoagulation service. Patients were asked how many times in the prior year they were requested to interrupt warfarin therapy for a medical or dental procedure or test and the specific indication for the requested interruption in warfarin therapy. A total of 1686 of 2133 (79%) subjects responded. The mean age of respondents was 69 years (SD=14 years). The majority were men (56%) and white (93%). Atrial fibrillation was the most common indication for warfarin therapy (n=966, 57%). At least 1 request to interrupt warfarin therapy in the prior year was given by 819 of 1648 (50%) respondents, including 481 of the 947 (51%) respondents taking warfarin for atrial fibrillation. Forty-eight percent of requests to interrupt warfarin among all respondents and 50% of requests to interrupt warfarin among those taking warfarin, specifically for atrial fibrillation, were for indications not supported by guideline statements.
CONCLUSIONS: Periprocedural requests to interrupt warfarin therapy are common and are often discordant with current guidelines. Educational interventions may decrease risk of periprocedural thromboembolic complications.
Authors:
Lesli E Skolarus; Lewis B Morgenstern; James B Froehlich; Lynda D Lisabeth; Devin L Brown
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-02-08
Journal Detail:
Title:  Circulation. Cardiovascular quality and outcomes     Volume:  4     ISSN:  1941-7705     ISO Abbreviation:  Circ Cardiovasc Qual Outcomes     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-16     Completed Date:  2011-07-28     Revised Date:  2011-10-27    
Medline Journal Info:
Nlm Unique ID:  101489148     Medline TA:  Circ Cardiovasc Qual Outcomes     Country:  United States    
Other Details:
Languages:  eng     Pagination:  206-10     Citation Subset:  IM    
Affiliation:
Stroke Program, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anticoagulants / contraindications*,  therapeutic use
Atrial Fibrillation / drug therapy*
Blood Loss, Surgical / prevention & control
Data Collection
Female
Humans
Male
Middle Aged
Oral Surgical Procedures
Patient Compliance*
Preoperative Care*
Risk Factors
Stroke / epidemiology
Surgical Procedures, Operative
Thromboembolism / epidemiology
Warfarin / contraindications*,  therapeutic use
Grant Support
ID/Acronym/Agency:
K23 NS051202/NS/NINDS NIH HHS
Chemical
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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