Hemorrhagic Complications of Oral Anticoagulant TherapyHemorrhagic complications of oral anticoagulant therapy
Section snippets
The Limitations of Studies Assessing the Hemorrhagic Complications of Anticoagulant Therapy in the Elderly
In systematically evaluating the literature concerning anticoagulant-related bleeding in the elderly, minimally two requirements are needed. First, studies need to report a clear definition of the outcome of interest (major bleeding). Second, studies need to include and define the patient sample of the population (the elderly) in which we are interested. Unfortunately, there has been no consistency over time for these two requirements.
The incidence of bleeding during anticoagulant therapy has
Sites of Hemorrhagic Complications from Oral Anticoagulant Therapy
The most common sites of anticoagulant-related bleeding are the gastrointestinal tract; the genitourinary tract; and soft tissues (including wounds).20, 22, 25, 42, 56, 80 Older patients may be at increased risk for gastrointestinal bleeding, especially when they are also taking nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs have been found to increase the risk of peptic ulcer disease in the elderly three to five times.24, 28 It is believed that this increased risk is from the inhibition
Major Determinants of Oral Anticoagulant-Related Bleeding
Major bleeding is the adverse effect that most limits the more widespread use of oral anticoagulant therapy. Concerns about potential anticoagulant-related bleeding may lead physicians to avoid initiating anticoagulant therapy in patients, such as the elderly, who might otherwise benefit the most.4, 7, 13, 21, 26, 27, 39, 50 Risk factors for anticoagulant-related bleeding can be divided into factors known at the start of anticoagulant therapy (i.e., baseline patient characteristics) and other
Summary
Hemorrhage is the major complication of anticoagulant therapy. The criteria for classifying the severity of bleeding has varied between studies, which has resulted in variability in the rate of bleeding reported in the literature. The major determinants of oral anticoagulant-related bleeding are the intensity of the anticoagulant effect, baseline patient characteristics, and the length of therapy. Older patients have characteristics that may place them at higher risk for anticoagulant-related
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Hemorrhagic Complications of Anticoagulant Therapy: Role of Multidetector Computed Tomography and Spectrum of Imaging Findings From Head to Toe
2012, Current Problems in Diagnostic RadiologyCitation Excerpt :Early recognition with prompt MDCT assessment is important to initiate, modify, or stop treatment, with the aim to reduce associated morbidity and mortality.3,4
Antithrombotic therapy in the elderly
2010, Journal of the American College of CardiologyCitation Excerpt :These issues may underline possible explanations for the substantial underutilization of vitamin K antagonists in the elderly population (52). However, even if elderly individuals have characteristics that may place them at higher risk for bleeding, they also have characteristics that make them more likely to benefit (53). Importantly, in the BAFTA (Birmingham Atrial Fibrillation Treatment of the Aged) trial, a randomized comparison of warfarin versus aspirin in 973 patients with atrial fibrillation age ≥75 years, the yearly risk of the combined primary end point of stroke, intracranial hemorrhage, or clinically significant embolism was 1.8% in patients who received warfarin and 3.8% in those who received aspirin (relative risk: 0.48, 95% CI: 0.28 to 0.80, p = 0.003) (54).
Occult trauma in high-risk populations
2003, Emergency Medicine Clinics of North AmericaDetermination of regimen fluindione needed for anticoagulation in the elderly
2002, Revue de Medecine Interne
Address reprint requests to, Rebecca J. Beyth, MD, MS, Houston VAMC (39A), Building 110T, 2002 Holcombe Boulevard, Houston, TX 77030
This work was supported in part by a NIA Mentored Clinical Investigator Award (K08-AG00712).