Document Detail


Switching from acenocoumarol to warfarin in patients with unstable anticoagulation and its effect on anticoagulation control.
MedLine Citation:
PMID:  19694217     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Unstable oral anticoagulation increases the risk of thrombotic events and bleedings. Acenocoumarol use has been reported to be associated with two-fold higher risk for instability of anticoagulation control compared to warfarin administration. OBJECTIVES: The aim of the study was to evaluate the effect of introducing warfarin on anticoagulation control in patients with a variable response to acenocoumarol. PATIENTS AND METHODS: Sixty-eight subjects treated with acenocoumarol for 5 months or more and displaying intraindividual variability of international normalized ratio (INR) results were switched to warfarin. Unstable anticoagulation was defined as a failure to achieve a target INR within the preceding 3 months, i.e. > or = 50% of 8 or more INR values below 2 or above 3.5. Patients with stable anticoagulation (<20% of out-of-range INRs), matched for age, gender, and anticoagulation indications, served as a reference group. RESULTS: Patients with unstable anticoagulation on acenocoumarol had higher body mass index (p<0.01) and serum C-reactive protein levels (p<0.01) compared to stable counterparts. The transition factor between acenocoumarol and warfarin was 1.8 (95% CI 1.69-1.96). The percentage time within the target INR range in patients with unstable anticoagulation was 40.2% at baseline and increased to 60.4% following 6 months on warfarin therapy (p<0.05). The number of subjects with <20% of out-of-range INRs among individuals switched from acenocoumarol to warfarin was 22 (32.4%) vs. 63 (92.6%) in patients on stable anticoagulation after 6 months of follow-up (p<0.001). CONCLUSIONS: Switching acenocoumarol to warfarin in patients with unstable anticoagulation can improve anticoagulation control.
Authors:
Anetta Undas; Mariola Cie?la-Dul; Marek Z??ci?ski; Wies?awa Tracz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Polskie Archiwum Medycyny Wewn?trznej     Volume:  119     ISSN:  0032-3772     ISO Abbreviation:  Pol. Arch. Med. Wewn.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-08-21     Completed Date:  2009-09-17     Revised Date:  2010-04-01    
Medline Journal Info:
Nlm Unique ID:  0401225     Medline TA:  Pol Arch Med Wewn     Country:  Poland    
Other Details:
Languages:  eng     Pagination:  360-5     Citation Subset:  IM    
Affiliation:
Institute of Cardiology, Jagiellonian University School of Medicine, Krak?w, Poland. mmundas@cyf-kr.edu.pl
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MeSH Terms
Descriptor/Qualifier:
Acenocoumarol / adverse effects*
Aged
Aged, 80 and over
Anticoagulants / adverse effects*
Case-Control Studies
Dose-Response Relationship, Drug
Female
Hemorrhage / chemically induced*,  prevention & control
Humans
International Normalized Ratio
Male
Middle Aged
Reproducibility of Results
Thromboembolism / drug therapy*
Treatment Outcome
Warfarin / administration & dosage*
Chemical
Reg. No./Substance:
0/Anticoagulants; 152-72-7/Acenocoumarol; 81-81-2/Warfarin

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


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