Coumadin Outweighs Hemorrhage Risk in Older Afib Patients

[Ross]

Interesting study:

http://www.medpagetoday.com/Cardiology/Arrhythmias/3868

My big caveat with it is, once again, missing data on INR's. I've said it a thousand times. If someone is PROPERLY anticoagulated and COMPLIANT with therapy by COMPETENT managers, there is very little risk associated with intracranial bleeds. Trauma to the head, regardless of cause, that results in an intracranial bleed is going to be a problem for anyone whether on Coumadin or not.

The authors noted several limitations of the study:

As an observational study of actual clinical practice, it was subject to non-standardized data collection, resulting in periods of missing warfarin exposure and unavailable INR data.
Because Coumadin treatment was not randomly assigned, confounding by contraindication may occur in that physicians are less likely to anticoagulate patients at higher risk for hemorrhage.

 

[skeptic49]

An interesting read. Thanks for posting. My mother is on Coumadin at age 83 and doing well having had a severe stroke about 20 years ago.

Jim

 

[olefin]

Interesting reading Ross!

I'll try to remember all that when I become an old fart.

 

[Blanche]

I am an "older" age person with Afib

I am an "older" age person with Afib

THank you, Ross.

You know that this speaks directly to me. I shall share this with my docs, especially the one who does not like giving anticoagulation to the "mature set."

Heck, I'm not mature any more....I was mature years ago. Now I am a salty old woman...and loving it.

Blanche

 

[Eva]

Thanks, Ross,

Good to know this, and I feel good that I do not personally have any worries at all about warfarin.

 

[Karlynn]

I agree Ross - I think we'd see much lower risk stats if people were properly managed. I know my MIL went to a Coumadin Clinic run by Bozo the Clown. My MIL was tested and would receive her INR a week later, with dose instructions. They had her scared spit-less to eat anything. Unfortunately, by the time I found out what was going on, she only had to be on Coumadin for another week. I found myself wondering how many other elderly patients they were mismanaging.

 

[Ross]

I agree Ross - I think we'd see much lower risk stats if people were properly managed. I know my MIL went to a Coumadin Clinic run by Bozo the Clown. My MIL was tested and would receive her INR a week later, with dose instructions. They had her scared spit-less to eat anything. Unfortunately, by the time I found out what was going on, she only had to be on Coumadin for another week. I found myself wondering how many other elderly patients they were mismanaging.

I can't find it now, but looking for studies on this subject I stumbled across one that was saying only 24% of labs know the ISI value of the reagents they are using. If that's the case, combined with managers that have no clue, it's easy to see why there would be catastrophies. I mean come on, how are you going to be able to give an INR number if you don't know the ISI of the reagent being used?

 

[Lynlw]

I can't find it now, but looking for studies on this subject I stumbled across one that was saying only 24% of labs know the ISI value of the reagents they are using. If that's the case, combined with managers that have no clue, it's easy to see why there would be catastrophies. I mean come on, how are you going to be able to give an INR number if you don't know the ISI of the reagent being used?

This may be what you are looking for. http://www.clinchem.org/cgi/content/full/52/5/793 I don't know how the machines are now it has been over 20 years since I did pt/ptts but then the machine just printed up the results.

 

[Ross]

This may be what you are looking for. http://www.clinchem.org/cgi/content/full/52/5/793 I don't know how the machines are now it has been over 20 years since I did pt/ptts but then the machine just printed up the results.

It's similiar, but the one I found I think was from 1993. I just breezed through it since it really wasn't what I was looking for.