PMID- 15277289
OWN - NLM
STAT- MEDLINE
DCOM- 20040820
LR  - 20131121
IS  - 0003-9926 (Print)
IS  - 0003-9926 (Linking)
VI  - 164
IP  - 14
DP  - 2004 Jul 26
TI  - The effect of excessive anticoagulation on mortality and morbidity in 
      hospitalized patients with anticoagulant-related major hemorrhage.
PG  - 1557-60
AB  - BACKGROUND: We aimed to determine the effect of excessive anticoagulation on 
      morbidity and mortality in hospitalized patients with major 
      anticoagulant-associated hemorrhage. METHODS: We prospectively identified 101 
      consecutive inpatients admitted to Brigham and Women's Hospital with major 
      bleeding occurring during administration of warfarin sodium, unfractionated 
      heparin (UFH), or low-molecular-weight heparin (LMWH). RESULTS: Fifty patients 
      had excessive and 51 had nonexcessive anticoagulation. The overall mortality at 
      60 days was 26% (13/50) in the excessive group compared with 10% (5/51) in the 
      nonexcessive group (P =.03). Excessive warfarin therapy was associated with an 
      increased 60-day mortality (P =.049), in contrast to excessive anticoagulation 
      with UFH or LMWH alone (P =.27) or UFH or LMWH as a "bridge" to warfarin therapy 
      (P =.10). Multivariate regression identified excessive anticoagulation as an 
      independent predictor of 60-day mortality (adjusted hazard ratio [HR], 4.17; 95% 
      confidence interval [CI], 1.39-12.49; P =.01), along with intracranial hemorrhage 
      (adjusted HR, 6.16; 95% CI, 1.75-21.67; P =.005) and active cancer (adjusted HR, 
      3.79; 95% CI, 1.13-12.70; P =.03). Excessive anticoagulation was also a 
      significant predictor of the combined nonfatal end point of stroke, myocardial 
      infarction, hypotension, critical anemia, and surgical or angiographic 
      intervention at 30 days (HR, 2.17; 95% CI, 1.25-3.78; P =.006). CONCLUSION: In a 
      cohort of patients with anticoagulation-associated hemorrhage, excessive 
      anticoagulation contributed independently to increased morbidity and mortality.
FAU - Koo, Sophia
AU  - Koo S
AD  - Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 
      Harvard Medical School, Boston, MA 02115, USA.
FAU - Kucher, Nils
AU  - Kucher N
FAU - Nguyen, Paul L
AU  - Nguyen PL
FAU - Fanikos, John
AU  - Fanikos J
FAU - Marks, Peter W
AU  - Marks PW
FAU - Goldhaber, Samuel Z
AU  - Goldhaber SZ
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Arch Intern Med
JT  - Archives of internal medicine
JID - 0372440
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - Arch Intern Med. 2005 Feb 14;165(3):349-50; author reply 350. PMID: 15710807
CIN - Arch Intern Med. 2005 Feb 14;165(3):349; author reply 350. PMID: 15710808
MH  - Adult
MH  - Aged
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Female
MH  - Hemorrhage/*chemically induced/mortality
MH  - Heparin/administration & dosage/adverse effects
MH  - Heparin, Low-Molecular-Weight/administration & dosage/adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Warfarin/adverse effects
EDAT- 2004/07/28 05:00
MHDA- 2004/08/21 05:00
CRDT- 2004/07/28 05:00
PHST- 2004/07/28 05:00 [pubmed]
PHST- 2004/08/21 05:00 [medline]
PHST- 2004/07/28 05:00 [entrez]
AID - 164/14/1557 [pii]
AID - 10.1001/archinte.164.14.1557 [doi]
PST - ppublish
SO  - Arch Intern Med. 2004 Jul 26;164(14):1557-60. doi: 10.1001/archinte.164.14.1557.