Skip header and navigation

Refine By

100 records – page 1 of 10.

Accuracy of coding for possible warfarin complications in hospital discharge abstracts.

https://arctichealth.org/en/permalink/ahliterature173437
Source
Thromb Res. 2006;118(2):253-62
Publication Type
Article
Date
2006
Author
T. Arnason
P S Wells
C. van Walraven
A J Forster
Author Affiliation
Ottawa Health Research Institute-Clinical Epidemiology Program, Canada.
Source
Thromb Res. 2006;118(2):253-62
Date
2006
Language
English
Publication Type
Article
Keywords
Anticoagulants - therapeutic use
Canada
Hemorrhage - complications
Hospitals, University
Humans
International Classification of Diseases
Medical Records
Reproducibility of Results
Retrospective Studies
Thromboembolism - complications
Warfarin - therapeutic use
Abstract
Hospital discharge abstracts could be used to identify complications of warfarin if coding for bleeding and thromboembolic events are accurate.
To measure the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9CM) codes for bleeding and thromboembolic diagnoses.
University affiliated, tertiary care hospital in Ottawa, Canada.
A random sample of patients discharged between September 1999 and September 2000 with an ICD-9-CM code indicating a bleeding or thromboembolic diagnosis.
Gold-standard coding was determined by a trained chart abstractor using explicit standard diagnostic criteria for bleeding, major bleeding, and acute thromboembolism. The abstractor was blinded to the original coding. We calculated the sensitivity, specificity, positive, and negative predictive values of the original ICD-9CM codes for bleeding or thromboembolism diagnoses.
We reviewed 616 medical records. 361 patients (59%) had a code indicating a bleeding diagnosis, 291 patients (47%) had a code indicating a thromboembolic diagnosis and 36 patients (6%) had a code indicating both. According to the gold standard criteria, 352 patients experienced bleeding, 333 experienced major bleeding, and 188 experienced an acute thromboembolism. For bleeding, the ICD-9CM codes had the following sensitivity, specificity, positive and negative predictive values [95% CI]: 93% [90-96], 88% [83-91], 91% [88-94], and 91% [87-94], respectively. For major bleeding, the ICD-9CM codes had the following sensitivity, specificity, positive and negative predictive values: 94% [91-96], 83% [78-87], 87% [83-90], and 92% [88-95], respectively. For thromboembolism, the ICD-9CM codes had the following sensitivity, specificity, positive and negative predictive values: 97% [94-99], 74% [70-79], 62% [57-68], and 98% [96-99], respectively. By selecting a sub-group of ICD-9CM codes for thromboembolism, the positive predictive value increased to 87%.
In our centre, the discharge abstract could be used to identify and exclude patients hospitalized with a major bleed or thromboembolism. If coding quality for bleeding is similar in other hospitals, these ICD-9-CM diagnostic codes could be used to study population-based warfarin-associated hemorrhagic complications using administrative databases.
PubMed ID
16081144 View in PubMed
Less detail

Age disparities in stroke quality of care and delivery of health services.

https://arctichealth.org/en/permalink/ahliterature149008
Source
Stroke. 2009 Oct;40(10):3328-35
Publication Type
Article
Date
Oct-2009
Author
Gustavo Saposnik
Sandra E Black
Antoine Hakim
Jiming Fang
Jack V Tu
Moira K Kapral
Author Affiliation
Stroke Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. saposnikg@smh.toronto.on.ca
Source
Stroke. 2009 Oct;40(10):3328-35
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Aging - physiology - psychology
Atrial Fibrillation - drug therapy - prevention & control
Cohort Studies
Cost of Illness
Deglutition Disorders - diagnosis - prevention & control - therapy
Emergency Medical Services - standards - statistics & numerical data - trends
Female
Health Policy
Health Services - economics
Hospital Units - standards - statistics & numerical data - trends
Hospitalization - economics
Humans
Longevity
Male
Middle Aged
Mortality - trends
Ontario
Outcome Assessment (Health Care) - economics
Patient Discharge - economics
Pneumonia - epidemiology
Prospective Studies
Quality of Health Care - statistics & numerical data - trends
Quality of Life
Severity of Illness Index
Stroke - complications - mortality - therapy
Thrombolytic Therapy - statistics & numerical data - trends
Warfarin - therapeutic use
Abstract
Limited information is available on the effect of age on stroke management and care delivery. Our aim was to determine whether access to stroke care, delivery of health services, and clinical outcomes after stroke are affected by age.
This was a prospective cohort study of patients with acute ischemic stroke in the province of Ontario, Canada, admitted to stroke centers participating in the Registry of the Canadian Stroke Network between July 1, 2003 and March 31, 2005. Primary outcomes were the following selected indicators of quality stroke care: (1) use of thrombolysis; (2) dysphagia screening; (3) admission to a stroke unit; (4) carotid imaging; (5) antithrombotic therapy; and (6) warfarin for atrial fibrillation at discharge. Secondary outcomes were risk-adjusted stroke fatality, discharge disposition, pneumonia, and length of hospital stay.
Among 3631 patients with ischemic stroke, 1219 (33.6%) were older than 80 years. There were no significant differences in stroke care delivery by age group. Stroke fatality increased with age, with a 30-day risk adjusted fatality of 7.1%, 6.5%, 8.8%, and 14.8% for those aged 59 or younger, 60 to 69, 70 to 79, and 80 years or older, respectively. Those aged older than 80 years had a longer length of hospitalization, increased risk of pneumonia, and higher disability at discharge compared to those younger than 80. This group was also less likely to be discharged home.
In the context of a province-wide coordinated stroke care system, stroke care delivery was similar across all age groups with the exception of slightly lower rates of investigations in the very elderly. Increasing age was associated with stroke severity and stroke case-fatality.
PubMed ID
19696418 View in PubMed
Less detail

An instrument for measuring health-related quality of life in patients with Deep Venous Thrombosis (DVT): development and validation of Deep Venous Thrombosis Quality of Life (DVTQOL) questionnaire.

https://arctichealth.org/en/permalink/ahliterature70975
Source
Health Qual Life Outcomes. 2004 Jun 23;2:30
Publication Type
Article
Date
Jun-23-2004
Author
Ewa Hedner
Jonas Carlsson
Károly R Kulich
Lennart Stigendal
Anders Ingelgård
Ingela Wiklund
Author Affiliation
Experimental Medicine, AstraZeneca, R&D, SE-431 83 Mölndal, Sweden. Ewa.Hedner@astrazeneca.com
Source
Health Qual Life Outcomes. 2004 Jun 23;2:30
Date
Jun-23-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Female
Humans
Male
Middle Aged
Pilot Projects
Psychometrics - instrumentation
Quality of Life - psychology
Questionnaires
Sex Factors
Sickness Impact Profile
Sweden
Treatment Outcome
Venous Thrombosis - drug therapy - physiopathology - psychology
Warfarin - therapeutic use
Abstract
BACKGROUND: Few studies have evaluated patient-reported outcomes in connection with a primary event of deep venous thrombosis, partly due to a lack of disease-specific measures. The aim here was to develop a disease-specific health-related quality of life (HRQL) measure, the deep venous thrombosis quality of life questionnaire (DVTQOL), for patients with recent exposition and treatment of proximal deep venous thrombosis. METHODS: A total of 121 consecutive outpatients (50 % males; mean age 61.2 +/- 14 years) treated with warfarin (Waran) for symptomatic proximal deep venous thrombosis were included in the study. Patients completed the SF-36, EQ-5D and the pilot version of the DVTQOL. RESULTS: Items having: high ceiling and floor effect, items with lower factor loadings than 0.50 and items loading in several factors were removed from the pilot version of DVTQOL. In addition, overlapping and redundant items identified by the Rasch analysis were excluded. The final DVTQOL questionnaire consists of 29 items composing six dimensions depicting problems with: emotional distress; symptoms (e.g. pain, swollen ankles, cramp, bruising); limitation in physical activity; hassle with coagulation monitoring; sleep disturbance; and dietary problems. The internal consistency reliability was high (alpha value ranged from 0.79 to 0.93). The relevant domains of the SF-36 and EQ-5D significantly correlated with DVTQOL, thereby confirming its construct validity. CONCLUSIONS: The DVTQOL is a short and user-friendly instrument with good reliability and validity. Its test-retest reliability and responsiveness to change in clinical trials, however, must be explored.
PubMed ID
15214965 View in PubMed
Less detail

Anticoagulants and Breast Cancer Survival: A Nationwide Cohort Study.

https://arctichealth.org/en/permalink/ahliterature308486
Source
Cancer Epidemiol Biomarkers Prev. 2020 01; 29(1):208-215
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
01-2020
Author
Pete T Kinnunen
Mika O Murto
Miia Artama
Eero Pukkala
Kala Visvanathan
Teemu J Murtola
Author Affiliation
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. pete.kinnunen@tuni.fi.
Source
Cancer Epidemiol Biomarkers Prev. 2020 01; 29(1):208-215
Date
01-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Anticoagulants - therapeutic use
Breast Neoplasms - complications - mortality
Drug Prescriptions - statistics & numerical data
Female
Finland - epidemiology
Follow-Up Studies
Heparin, Low-Molecular-Weight - therapeutic use
Humans
Middle Aged
Registries - statistics & numerical data
Retrospective Studies
Risk factors
Survival Analysis
Venous Thromboembolism - drug therapy - epidemiology - etiology
Warfarin - therapeutic use
Abstract
Various components of the coagulation cascade have been linked to breast cancer progression. In vivo results suggest that anticoagulants possess anticancer properties, but there are virtually no studies in human populations. Our nationwide study explored the association between anticoagulant use and breast cancer survival.
All anticoagulants used from 1995 to 2015 in women (n = 73,170) diagnosed with invasive breast cancer in Finland between 1995 and 2013 were identified from the national prescription database; women were identified from the Finnish Cancer Registry. Cox regressions were performed to analyze breast cancer survival as a function of pre- and postdiagnostic anticoagulant use; analyses were conducted for different anticoagulant subtypes and overall. Models were adjusted for age, mammography screening, tumor clinical characteristics, comorbidities, statin use, antidiabetic use, and antihypertensive use. To control for immortal time bias, postdiagnostic anticoagulant use was analyzed as a time-dependent variable.
At a median of 5.8 years after breast cancer diagnosis, 10,900 (15%) women had died from breast cancer. In total, 25,622 (35%) women had used anticoagulants during the study period. Postdiagnostic anticoagulant use increased the risk of breast cancer death (HR = 1.41; 95% confidence interval, 1.33-1.49). The risk was especially high for low-molecular weight heparin, although the effect disappeared in long-term users.
Anticoagulant use provides no clinical benefit for breast cancer survival; however, the association between thrombosis and cancer might mask potential survival benefits.
Future pharmacoepidemiologic studies should adjust for anticoagulant use. Research should focus on the use of new oral anticoagulants because these are rarely studied and might be associated with improved breast cancer survival.
PubMed ID
31653681 View in PubMed
Less detail

Anticoagulants and cancer mortality in the Finnish randomized study of screening for prostate cancer.

https://arctichealth.org/en/permalink/ahliterature310416
Source
Cancer Causes Control. 2019 Aug; 30(8):877-888
Publication Type
Journal Article
Randomized Controlled Trial
Date
Aug-2019
Author
P T T Kinnunen
T J Murtola
K Talala
K Taari
T L J Tammela
A Auvinen
Author Affiliation
School of Medicine, University of Tampere, Tampere, Finland. Kinnunen.Pete.T@student.uta.fi.
Source
Cancer Causes Control. 2019 Aug; 30(8):877-888
Date
Aug-2019
Language
English
Publication Type
Journal Article
Randomized Controlled Trial
Keywords
Aged
Anticoagulants - therapeutic use
Early Detection of Cancer
Finland - epidemiology
Heparin, Low-Molecular-Weight - therapeutic use
Humans
Male
Middle Aged
Prostatic Neoplasms - diagnosis - drug therapy - mortality
Risk factors
Warfarin - therapeutic use
Abstract
Anticoagulants may reduce mortality of cancer patients, though the evidence remains controversial. We studied the association between different anticoagulants and cancer death.
All anticoagulant use during 1995-2015 was analyzed among 75,336 men in the Finnish Randomized Study of Screening for Prostate Cancer. Men with prevalent cancer were excluded. Multivariable Cox regression was performed to compare risk of death from any cancer and disease-specific death from 9 specific cancer types between (1) anticoagulant users overall and (2) warfarin users compared to anticoagulant non-users and (3) warfarin or (4) low-molecular-weight heparins (LMWH) compared to users of other anticoagulants. Medication use was analyzed as time-dependent variable to minimize immortal time bias. 1-, 2- and 3-year lag-time analyses were performed.
During a median follow-up of 17.2 years, a total of 27,233 men died of whom 8033 with cancer as the primary cause of death. In total, 32,628 men (43%) used anticoagulants. Any anticoagulant use was associated with an increased risk of cancer death (HR?=?2.50, 95% CI 2.37-2.64) compared to non-users. Risk was similar independent of the amount, duration, or intensity of use. The risk increase was observed both among warfarin and LMWH users, although not as strong in warfarin users. Additionally, cancer-specific risks of death were similar to overall cancer mortality in all anticoagulant categories.
Our study does not support reduced cancer mortality among anticoagulant users. Future studies on drug use and cancer mortality should be adjusted for anticoagulants as they are associated with significantly higher risk of cancer death.
PubMed ID
31209595 View in PubMed
Less detail

Anticoagulant treatment in primary health care in Sweden - prevalence, incidence and treatment diagnosis: a retrospective study on electronic patient records in a registered population.

https://arctichealth.org/en/permalink/ahliterature52156
Source
BMC Fam Pract. 2003 Apr 1;4:3
Publication Type
Article
Date
Apr-1-2003
Author
Gunnar H Nilsson
Ingela Björholt
Hans Johnsson
Author Affiliation
Department of Medicine, Research Unit of General Practice, Karolinska Institutet, Stockholm, Sweden. gunnar.nilsson@nlpo.sll.se
Source
BMC Fam Pract. 2003 Apr 1;4:3
Date
Apr-1-2003
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Atrial Fibrillation - complications
Cerebrovascular Accident - prevention & control
Cerebrovascular Disorders - complications - drug therapy
Female
Humans
Incidence
Male
Middle Aged
Prevalence
Primary Health Care
Research Support, Non-U.S. Gov't
Retrospective Studies
Risk factors
Sweden
Venous Thrombosis - complications - drug therapy
Warfarin - therapeutic use
Abstract
BACKGROUND: The indications for warfarin treatment in primary health care are increasing. An undertreatment with warfarin is reported in the prevention of embolic stroke in patients with chronic atrial fibrillation, and can be suspected for other indications. Information on the prevalence and incidence of diseases treated with warfarin would reveal useful data for audits concerning management of anticoagulant treatment. We aimed to assess warfarin treatment in primary health care with regard to prevalence, incidence, treatment diagnosis and patient characteristics. METHODS: A one-year retrospective study of electronic patient records up to May 2000 in primary health care in Stockholm, Sweden. Five primary health care centres with a registered population of 75 146. Main outcome measures were prevalence, incidence and treatment diagnosis. RESULTS: Five hundred and seven patients, mean age 71.9 years, were on warfarin treatment. The prevalence was 0.67% (age-adjusted 0.75%), and it was significantly higher for men (0.78%) than for women (0.58%) (p = 0.01). In the age group 75-84 years the prevalence was 4.54%. The most prevalent treatment diagnosis was chronic atrial fibrillation (0.28%), which was more predominant for males (p = 0.02), followed by cerebrovascular disease (0.13%) and deep venous thrombosis (0.13%). The yearly incidence of warfarin treatment was 0.17%, with chronic atrial fibrillation as the predominant treatment diagnosis. CONCLUSION: Warfarin treatment in primary health care is prevalent among the elderly. Chronic atrial fibrillation is the main treatment diagnosis. There is a gender difference favouring men in general and chronic atrial fibrillation as the treatment diagnosis.
PubMed ID
12675952 View in PubMed
Less detail

Anticoagulant treatment of patients with chronic atrial fibrillation in primary health care in Sweden--a retrospective study of incidence and quality in a registered population.

https://arctichealth.org/en/permalink/ahliterature51950
Source
Fam Pract. 2004 Dec;21(6):612-6
Publication Type
Article
Date
Dec-2004
Author
Gunnar H Nilsson
Ingela Björholt
Ingvar Krakau
Author Affiliation
Department of Clinical Sciences, Center of Family Medicine, Karolinska Institute, Stockholm, Sweden. gunnar.nilsson@nlpo.sll.se
Source
Fam Pract. 2004 Dec;21(6):612-6
Date
Dec-2004
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Anticoagulants - therapeutic use
Atrial Fibrillation - drug therapy - epidemiology
Chronic Disease
Cohort Studies
Community health centers - standards
Drug Utilization Review
Female
Humans
Incidence
Linear Models
Male
Medical Records Systems, Computerized
Middle Aged
Prevalence
Primary Health Care - standards
Quality of Health Care
Research Support, Non-U.S. Gov't
Sweden - epidemiology
Time Factors
Warfarin - therapeutic use
Abstract
BACKGROUND: The number of patients receiving anticoagulant treatment is increasing. Chronic atrial fibrillation is the most common treatment diagnosis. The literature indicates a variable level of treatment control. Estimates of time within the therapeutic range have been recommended as a measurement of quality. Electronic patient records are providing clinical data that are useful for audits concerning anticoagulant treatment in real-life practice. OBJECTIVE: Our aim was to assess warfarin treatment for chronic atrial fibrillation in primary health care with regard to prevalence, incidence and quality. METHODS: A 2 year retrospective study was carried out of electronic patient records up to April 2002 in primary health care in Stockholm, including 12 primary health care centres with a registered population of 203 407. Main outcome measures were the number of new patients on wafarin treatment for chronic atrial fibrillation, and time within the therapeutic prothrombin range in the first 90 days of treatment using a linear interpolation method. RESULTS: In total, 827 patients were on warfarin treatment for chronic atrial fibrillation, giving a prevalence of 0.41%. Of these, 144 patients (study group) started treatment with warfarin for chronic atrial fibrillation during the study period, giving a yearly incidence of 0.07%. Their mean age was 73.1 years and 61.1% were men. There were 1721 prothrombin monitoring episodes registered in the first 90 days of treatment, on average once a week per patient. The average proportion of time within the therapeutic range was 54.1% (95% confidence interval (CI) 50.1-58.1), and the proportion of therapeutic tests was 50.2% (95% CI 47.8-52.6). CONCLUSIONS: During the first, second and third months of warfarin treatment for chronic atrial fibrillation, patients were outside the therapeutic range time nearly half the time. There was a gender difference favouring men regarding initiation of treatment.
PubMed ID
15465879 View in PubMed
Less detail

Anticoagulation management in remote primary care.

https://arctichealth.org/en/permalink/ahliterature167798
Source
Can Fam Physician. 2005 Mar;51:384-5
Publication Type
Article
Date
Mar-2005
Author
Shauna L Nast
Martin J Tierney
Ray McIlwain
Author Affiliation
University of British Columbia, Vancouver.
Source
Can Fam Physician. 2005 Mar;51:384-5
Date
Mar-2005
Language
English
Publication Type
Article
Keywords
Aged
Anticoagulants - therapeutic use
Blood Coagulation Disorders - drug therapy
British Columbia
Female
Humans
International Normalized Ratio
Male
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Primary Health Care - statistics & numerical data
Rural Health Services - statistics & numerical data
Warfarin - therapeutic use
Abstract
To examine anticoagulation management at the Bella Coola Medical Clinic in British Columbia.
Charts of all patients in the Bella Coola Valley receiving warfarin were assessed. Data were analyzed using Microsoft Excel.
Bella Coola Medical Clinic on the remote central coast of British Columbia.
Twenty-one patients at the Bella Coola Medical Clinic who were receiving warfarin.
All international normalized ratio (INR) tests over the preceding 12 months were examined for results, time elapsed since previous test, and interval until next scheduled test.
An in-range INR rate of 60% is considered acceptable for anticoagulation services. The clinic had performed 406 INR tests on these 21 patients over the last 12 months. We found that 53% of all INR results fell strictly within the recommended therapeutic range. The relative success of anticoagulation management in Bella Coola probably results from several factors. For instance, physicians usually responded to out-of-range INR results with close monitoring: in 71% of cases, follow-up tests were scheduled within 1 week. On average, patients attended 77% of these visits on schedule; 58% of all out-of-range INR results were followed up with retesting within 1 week.
Our results suggest that primary care physicians can manage anticoagulation adequately, even in remote settings.
Notes
Cites: Arch Intern Med. 2000 Apr 10;160(7):967-7310761962
Cites: Br J Gen Pract. 2000 Oct;50(459):779-8011127164
Cites: Can Fam Physician. 2003 Feb;49:181-412619741
Cites: Circulation. 2003 Aug 12;108(6):711-612885749
Cites: CMAJ. 2003 Aug 19;169(4):293-812925422
Cites: Chest. 1998 Nov;114(5 Suppl):445S-469S9822057
Cites: CMAJ. 1999 Sep 7;161(5):493-710497604
PubMed ID
16926932 View in PubMed
Less detail

Anticoagulation therapy among patients presenting to the emergency department with symptomatic atrial fibrillation - the FinFib2 study.

https://arctichealth.org/en/permalink/ahliterature291913
Source
Eur J Emerg Med. 2017 Oct; 24(5):347-352
Publication Type
Journal Article
Date
Oct-2017
Author
Tero Penttilä
Heikki Mäkynen
Juha Hartikainen
Timo Lauri
Mika Lehto
Juha Lund
Markku Mäkijärvi
Pekka Raatikainen
Author Affiliation
aHeart Center, Tampere University Hospital, Tampere bHeart Center, Kuopio University Hospital, Kuopio cOulu University Hospital, Oulu dHeart and Lung Center, Helsinki University Hospital, Helsinki eTurku University Hospital, Turku fUniversity of Eastern Finland, Jyväskylä, Finland.
Source
Eur J Emerg Med. 2017 Oct; 24(5):347-352
Date
Oct-2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Anticoagulants - therapeutic use
Atrial Fibrillation - drug therapy
Emergency Service, Hospital - statistics & numerical data
Female
Finland - epidemiology
Hemorrhage - epidemiology
Humans
International Normalized Ratio - statistics & numerical data
Male
Prospective Studies
Risk factors
Stroke - prevention & control
Thromboembolism - epidemiology
Warfarin - therapeutic use
Abstract
Atrial fibrillation (AF) causes numerous visits to emergency departments (EDs). We evaluated the thromboembolic and bleeding risk profile and use of oral anticoagulation (OAC) therapy among patients presenting with symptomatic AF to ED.
Within a 2-week period, all patients whose primary reason for the ED visit was AF were enrolled into this prospective study in 35 EDs around Finland. The risk of thromboembolic and bleeding events was assessed by the CHA2DS2VASc and the HAS-BLED score, respectively. Thereafter, we evaluated whether OAC was used according to the contemporary management guidelines.
The study population included 1013 patients (mean age 70±13 years, 52.4% men) with newly or previously diagnosed symptomatic AF. The mean CHA2DS2VASc and HAS-BLED score was 3.1±2.1 and 1.9±1.2, respectively. At admission, 76.3% of the patients with previously diagnosed AF and CHA2DS2VASc score of at least 2 were using OAC (warfarin 92.3%). However, the international normalized ratio was not at the therapeutic level in 41.9% of them. At discharge, 84.1% of the high-risk patients (85.5% of previously diagnosed and 79.6% of newly diagnosed) and 57.0 and 37.0% of the moderate-risk and low-risk patients were on OAC, respectively. Of the high-risk patients, 5.4% were treated with aspirin.
These data showed that OAC was prescribed frequently to patients with symptomatic AF and risk factors for stroke. However, in patients using warfarin, international normalized ratio was not at the therapeutic level in a large proportion of the patients with previously diagnosed AF.
PubMed ID
27097066 View in PubMed
Less detail

Antiphospholipid antibodies and venous thromboembolism.

https://arctichealth.org/en/permalink/ahliterature213849
Source
Blood. 1995 Nov 15;86(10):3685-91
Publication Type
Article
Date
Nov-15-1995
Author
J S Ginsberg
P S Wells
P. Brill-Edwards
D. Donovan
K. Moffatt
M. Johnston
P. Stevens
J. Hirsh
Author Affiliation
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Source
Blood. 1995 Nov 15;86(10):3685-91
Date
Nov-15-1995
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Antibodies, Anticardiolipin - analysis
Antibodies, Antiphospholipid - analysis
Anticoagulants - therapeutic use
Antiphospholipid Syndrome - complications
Autoimmune Diseases - complications
Female
Humans
Lupus Coagulation Inhibitor - analysis
Male
Middle Aged
Ontario - epidemiology
Predictive value of tests
Prospective Studies
Pulmonary Embolism - drug therapy - epidemiology - etiology
Thrombophlebitis - drug therapy - epidemiology - etiology
Warfarin - therapeutic use
Abstract
The clinical relevance of antiphospholipid antibodies (APLA) in patients without systemic lupus erythematosus who have venous thromboembolism (VTE) in unknown. Limited evidence suggests that there is an association between the presence of APLA and both initial and recurrent episodes of VTE and that patients with APLA and VTE are resistant to warfarin therapy. Unselected patients with a first episode of clinically suspected deep vein thrombosis or pulmonary embolism were evaluated with objective tests for VTE and with laboratory tests for APLA; the latter included tests for the lupus anticoagulant (LA) and anticardiolipin antibodies (ACLA). Patients with VTE were treated with anticoagulant therapy and observed during and after discontinuation of anticoagulants for symptomatic recurrence of VTE. There was a strong association between LA and VTE (odds ratio, 9.4; 95% confidence interval [CI], 2.1 to 46.2) and 9 to 65 (14%; 95% CI, 7% to 25%) patients with VTE had LA. There was no association between the presence of ACLA and VTE (odds ratio, 0.7; 95%CI, 0.3 to 1.7) because of the high frequency of positive ACLA assays in patients without VTE. None of the 16 patients with VTE and APLA developed recurrent VTE while receiving warfarin therapy. There was no difference in rates of recurrent VTE in patients with or without APLA after anticoagulant therapy was discontinued. The strong association between LA and VTE suggests that testing for LA in patients with VTE is useful. The measurement of ACLA in patients with VTE has no clinical usefulness because the results are abnormal in a high proportion of patients without VTE. Although the presence of APLA in patients with VTE was not associated with resistance to a conventional intensity of warfarin or an increased risk of recurrent VTE after discontinuation of warfarin, a larger study should address these issues in a subgroup of patients with VTE and LA.
PubMed ID
7579334 View in PubMed
Less detail

100 records – page 1 of 10.