PMID- 24549520
OWN - NLM
STAT- MEDLINE
DCOM- 20150129
LR  - 20220409
IS  - 1525-1497 (Electronic)
IS  - 0884-8734 (Print)
IS  - 0884-8734 (Linking)
VI  - 29
IP  - 6
DP  - 2014 Jun
TI  - Outcomes of anticoagulation therapy in patients with mental health conditions.
PG  - 855-61
LID - 10.1007/s11606-014-2784-2 [doi]
AB  - BACKGROUND: Patients with mental health conditions (MHCs) experience poor 
      anticoagulation control when using warfarin, but we have limited knowledge of the 
      association between specific mental illness and warfarin treatment outcomes. 
      OBJECTIVE: To examine the relationship between the severity of MHCs and outcomes 
      of anticoagulation therapy. DESIGN: Retrospective cohort analysis. PARTICIPANTS: 
      We studied 103,897 patients on warfarin for 6 or more months cared for by the 
      Veterans Health Administration during fiscal years 2007-2008. We identified 
      28,216 patients with MHCs using ICD-9 codes: anxiety disorders, bipolar disorder, 
      depression, post-traumatic stress disorder, schizophrenia, and other psychotic 
      disorders. MAIN MEASURES: Outcomes included anticoagulation control, as measured 
      by percent time in the therapeutic range (TTR), as well as major hemorrhage. 
      Predictors included different categories of MHC, Global Assessment of Functioning 
      (GAF) scores, and psychiatric hospitalizations. KEY RESULTS: Patients with 
      bipolar disorder, depression, and other psychotic disorders experienced TTR 
      decreases of 2.63 %, 2.26 %, and 2.92 %, respectively (p < 0.001), after 
      controlling for covariates. Patients with psychotic disorders other than 
      schizophrenia experienced increased hemorrhage after controlling for covariates 
      [hazard ratio (HR) 1.24, p = 0.03]. Having any MHC was associated with a slightly 
      increased hazard for hemorrhage (HR 1.19, p < 0.001) after controlling for 
      covariates. CONCLUSION: Patients with specific MHCs (bipolar disorder, 
      depression, and other psychotic disorders) experienced slightly worse 
      anticoagulation control. Patients with any MHC had a slightly increased hazard 
      for major hemorrhage, but the magnitude of this difference is unlikely to be 
      clinically significant. Overall, our results suggest that appropriately selected 
      patients with MHCs can safely receive therapy with warfarin.
FAU - Paradise, Helen T
AU  - Paradise HT
AD  - Department of Community Based Clinics, University of Texas Medical Branch (UTMB), 
      6465 South Shore Blvd. Suite 500, League City, TX, 77573, USA, helenjt@gmail.com.
FAU - Berlowitz, Dan R
AU  - Berlowitz DR
FAU - Ozonoff, Al
AU  - Ozonoff A
FAU - Miller, Donald R
AU  - Miller DR
FAU - Hylek, Elaine M
AU  - Hylek EM
FAU - Ash, Arlene S
AU  - Ash AS
FAU - Jasuja, Guneet K
AU  - Jasuja GK
FAU - Zhao, Shibei
AU  - Zhao S
FAU - Reisman, Joel I
AU  - Reisman JI
FAU - Rose, Adam J
AU  - Rose AJ
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
DEP - 20140219
PL  - United States
TA  - J Gen Intern Med
JT  - Journal of general internal medicine
JID - 8605834
RN  - 0 (Anticoagulants)
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
CIN - J Gen Intern Med. 2014 Jun;29(6):892. PMID: 24595423
MH  - Adult
MH  - Aged
MH  - Anticoagulants/administration & dosage/adverse effects
MH  - *Atrial Fibrillation/complications/epidemiology/psychology
MH  - Blood Coagulation/drug effects
MH  - Cohort Studies
MH  - Comorbidity
MH  - Drug Monitoring
MH  - Female
MH  - *Hemorrhage/chemically induced/epidemiology/prevention & control
MH  - Humans
MH  - Male
MH  - *Mental Disorders/blood/diagnosis/epidemiology
MH  - Middle Aged
MH  - Proportional Hazards Models
MH  - Psychiatric Status Rating Scales
MH  - Retrospective Studies
MH  - Risk Adjustment
MH  - Risk Factors
MH  - Thromboembolism/etiology/*prevention & control
MH  - United States/epidemiology
MH  - *Warfarin/administration & dosage/adverse effects
PMC - PMC4026501
EDAT- 2014/02/20 06:00
MHDA- 2015/01/30 06:00
PMCR- 2015/06/01
CRDT- 2014/02/20 06:00
PHST- 2013/07/03 00:00 [received]
PHST- 2014/01/12 00:00 [accepted]
PHST- 2013/12/03 00:00 [revised]
PHST- 2014/02/20 06:00 [entrez]
PHST- 2014/02/20 06:00 [pubmed]
PHST- 2015/01/30 06:00 [medline]
PHST- 2015/06/01 00:00 [pmc-release]
AID - 2784 [pii]
AID - 10.1007/s11606-014-2784-2 [doi]
PST - ppublish
SO  - J Gen Intern Med. 2014 Jun;29(6):855-61. doi: 10.1007/s11606-014-2784-2. Epub 
      2014 Feb 19.