PMID- 20399987
OWN - NLM
STAT- MEDLINE
DCOM- 20100730
LR  - 20131121
IS  - 1879-114X (Electronic)
IS  - 0149-2918 (Linking)
VI  - 32
IP  - 3
DP  - 2010 Mar
TI  - Effect of heart failure exacerbations on anticoagulation: a prospective, 
      observational, pilot cohort study.
PG  - 506-14
LID - 10.1016/j.clinthera.2010.03.001 [doi]
AB  - BACKGROUND: Some studies have suggested that heart failure (HF) is associated 
      with excessive anticoagulation, but definitive data or data showing causation do 
      not exist. Knowledge of risk factors for excessive anticoagulation is critical to 
      manage warfarin therapy safely. OBJECTIVE: This study characterized the relation 
      between HF-associated hypervolemia and excessive anticoagulation in patients with 
      HF taking chronic warfarin therapy. METHODS: This was a prospective, 
      observational pilot study conducted in a university-based HF clinic. Patients 
      aged 18 to 85 years with HF and taking warfarin were enrolled and were observed 
      for episodes of hypervolemia. Hypervolemia was determined based on multiple 
      clinical factors, including patient-reported symptoms and physical examination. 
      Anticoagulation was assessed longitudinally per standard of care by measurement 
      of the international normalized ratio (INR). A chi(2) analysis was used to 
      determine whether hypervolemia was associated with an increased risk of excessive 
      anticoagulation. Paired and unpaired t tests were used for ad hoc analyses. 
      RESULTS: Forty patients with 41 HF episodes who were taking warfarin were 
      enrolled between December 2003 and July 2007. Mean (SD) age was 67.2 (11.1) years 
      and mean weight was 218.5 (62.8) pounds; 29 patients (72.5%) were men and 34 
      (85.0%) were white. Most had systolic dysfunction (n = 26; 65.0%) and were taking 
      warfarin for atrial fibrillation (n = 33; 82.5%); the mean weekly warfarin dose 
      was 30.8 (17.5) mg. There were 41 evaluable hypervolemia episodes over a mean 
      follow-up of 14.5 (9.0) months. The mean INR change during hypervolemia was -0.02 
      (0.82) INR unit (P = NS vs baseline). No association was found between 
      hypervolemia episodes and INR increases of > or =50% (P = NS); the results 
      remained nonsignificant for both diastolic and systolic HF when analyzed 
      separately. There was no significant change from baseline INR between patients 
      classified with mild, moderate, or severe hypervolemia or between patients 
      classified according to New York Heart Association (NYHA) functional class (all, 
      P = NS). Patients with NYHA class III had a lower weekly warfarin dose than those 
      with NYHA class II (25.73 vs 31.75 mg; P < 0.01). CONCLUSION: Mild hypervolemia 
      did not appear to be related to excessive anticoagulation in these patients with 
      HF taking chronic warfarin therapy.
CI  - Copyright 2010 Excerpta Medica Inc. All rights reserved.
FAU - Ripley, Toni L
AU  - Ripley TL
AD  - Department of Pharmacy: Clinical and Administrative Sciences, University of 
      Oklahoma College of Pharmacy, Oklahoma City, Oklahoma 73126, USA. 
      toni-ripley@ouhsc.edu
FAU - Harrison, Donald
AU  - Harrison D
FAU - Germany, Robin E
AU  - Germany RE
FAU - Adamson, Philip B
AU  - Adamson PB
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Clin Ther
JT  - Clinical therapeutics
JID - 7706726
RN  - 0 (Anticoagulants)
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/administration & dosage/*adverse effects/therapeutic use
MH  - Atrial Fibrillation/drug therapy
MH  - *Blood Volume
MH  - Cohort Studies
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/*complications
MH  - Humans
MH  - International Normalized Ratio
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - Pilot Projects
MH  - Prospective Studies
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Warfarin/administration & dosage/*adverse effects/therapeutic use
EDAT- 2010/04/20 06:00
MHDA- 2010/07/31 06:00
CRDT- 2010/04/20 06:00
PHST- 2009/12/22 00:00 [accepted]
PHST- 2010/04/20 06:00 [entrez]
PHST- 2010/04/20 06:00 [pubmed]
PHST- 2010/07/31 06:00 [medline]
AID - S0149-2918(10)00092-5 [pii]
AID - 10.1016/j.clinthera.2010.03.001 [doi]
PST - ppublish
SO  - Clin Ther. 2010 Mar;32(3):506-14. doi: 10.1016/j.clinthera.2010.03.001.