Resumption Of Oral Anticoagulation Research Articles

STROKE AND BLEEDING RISK IN PATIENTS WITH ATRIAL FIBRILLATION WITH RESUMPTION OF ORAL ANTICOAGULATION FOLLOWING TRAUMATIC INJURY: A DANISH NATIONWIDE COHORT STUDY

With increasing age, patients with atrial fibrillation (AF) also are at higher risk of falls causing traumatic injury, leading to bleeding risks. We examined the risks of all-cause mortality, stroke, and major bleeding associated with resumption of oral anticoagulation (OAC) after traumatic injury

LAA ligation using the LARIAT suture delivery device: Tips and tricks for a successful procedure

Chronic oral anticoagulation (OAC) has traditionally been considered as the most effective prophylaxis against thromboembolic events in patients with atrial fibrillation (AF). However, as many as 20% of the patients with AF are not candidates for OAC.1,2 Reasons for ineligibility range from intracranial bleeding (the most serious complication) to increased propensity for mechanical injury (the least serious complication). The resumption of OAC in patients who have suffered a life-threatening complication due to OAC is associated with a much higher risk of such events in the future.

Resumption of Oral Anticoagulation After Warfarin-Associated Intracerebral Hemorrhage

The decision on restarting warfarin means to balance between 2 risks: ischemic stroke and rebleeding. Without any secondary prophylaxis, this patient has an annual stroke risk rate of 5.9% according to his CHADS2 score of 3 and anticoagulation is recommended as thromboprophylaxis in patients with atrial fibrillation and a CHADS2 score of ≥2.1 These recommendations, however, cannot be directly applied to patients with bleeding complications. No prospective data are available that particularly looked at patients with atrial fibrillation, a CHADS2 score ≥2 (or need for anticoagulation), and an intracranial bleeding that occurred in association with warfarin treatment. Smaller retrospective studies report low risk of ischemic events during the first 3 weeks before warfarin was restarted. The largest retrospective analysis reported rebleedings both in patients who resumed warfarin …

Resumption of Oral Anticoagulation After Warfarin-Associated Intracerebral Hemorrhage

A hematology/thrombosis consultation for a patient admitted with warfarin-associated intracerebral hemorrhage (ICH) should take into account the indication for anticoagulation, the treatment history with warfarin, any possible precipitating risk factors for the hemorrhage, the location of the hematoma, and the condition of the patient. Finally, the balance between the risk for ischemic stroke without anticoagulation and the risk of recurrent ICH with resumed anticoagulation should be assessed. Until recently, expert opinion1 as well as systematic reviews2,3 were favoring early resumption, that is, after 3 to 14 days, of anticoagulation in stable patients. A retrospective study of 234 patients with warfarin-associated ICH concluded that the resumption should be delayed by 10 to 30 weeks to avoid the early high-risk period for recurrent hemorrhage, during which full anticoagulation appeared to increase this risk 5-fold.4 In risk modeling, it could be calculated from the data in this study that resumption of warfarin after 1 month …

Clinical factors influencing the sensitivity to warfarin when restarted after surgery

Resumption of oral anticoagulation after surgery may result in a different maintenance dose of warfarin than before the procedure. Knowledge of the clinical determinants of postoperative response could help avoid excessive anticoagulation in sensitive patients or avoid extended delays in achieving a therapeutic level in resistant patients. Retrospective review. Two hundred warfarin-treated patients who were managed by our clinic for surgery. Two independent adjudicators classified the postoperative response to warfarin as Resistant, Normal or Sensitive, based on previous maintenance dose, international normalized ratio (INR) on the day of resumption, number of days until INR of >1.9 and doses of warfarin given. A third adjudicator resolved disagreements. Clinical data were extracted from the patient records and correlated with the response. Interobserver agreement for classification of postoperative response was moderate (weighted kappa 0.46) with 37 (18.5%) considered resistant, 135 (67.5%) normal, 27 (13.5%) sensitive and one patient was not classifiable. The main type of surgery was cardiac. In univariable analysis only addition of amiodarone after surgery was associated with a sensitive response (P = 0.04). After adjustment for all other factors with an ordered categorical response, amiodarone remained as the sole independent risk factor (P = 0.02) for a sensitive response, odds ratio 0.41 (95% confidence interval 0.19-0.89) for Normal instead of Sensitive or for Resistant instead of Normal. Altered sensitivity to warfarin occurs in about one-third of patients after surgery and can be predicted by the introduction of concomitant amiodarone therapy but not by patient factors or the nature of the procedure. Changes in concomitant medications after surgery should alert doctors of the potential for increased sensitivity to warfarin.