Evaluation of risk factors for stroke/embolism and of complications due to anticoagulant therapy in atrial fibrillation.
OBJECTIVE
We sought to assess in outpatients with atrial fibrillation and oral anticoagulation (1) whether the complication rate is influenced by the presence of the risk factors age >65 years, arterial hypertension, diabetes, or previous stroke; (2) whether the complication rate is influenced by the number of additional drugs taken by patients; and (3) whether problems and interventions differ between patients with or without complications.


METHODS
- Clinical characteristics, drugs, problems, interventions, and complications were registered during 2 years.


RESULTS
- Three hundred sixty patients (mean age, 68 years; 43% female) were observed for 383 patient-years. Patients aged >65 years had more serious, life-threatening, or fatal complications (11% versus 5.3%/100 patient-years; P=0.0428) than younger patients. Patients with diabetes had more life-threatening and fatal complications (2.8% versus 0.6%/100 patient-years; P=0.0354) than patients without. The complication rate did not differ regarding the presence of previous stroke or hypertension. Patients who took </=3 drugs had fewer complications than patients who took more (4.3% versus 24.4%/100 patient-years; P=0.0041). Patients with complications complained more of chest (48% versus 28%/100 patient-years; P=0.0113) and abdominal pain (30% versus 13%/100 patient-years; P=0.0057), more frequently failed to keep appointments (134% versus 107%/100 patient-years; P=0.0321), had a higher tracking rate (134% versus 105%/100 patient-years; P=0.0272), and took more additional drugs (4.6 versus 3.5 drugs per day; P=0.0063) than patients with no complications.


CONCLUSIONS
- Patients with increased age or diabetes mellitus or those who take >3 drugs per day have an increased complication rate and thus need especially careful monitoring of oral anticoagulation, including adequate pain control.
Wehinger
C
C
Second Medical Department, KA Rudolfstiftung, Vienna, Austria.
Stöllberger
C
C
Länger
T
T
Schneider
B
B
Finsterer
J
J
D000284:Administration, Oral; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D023381:Endpoint Determination; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D020766:Intracranial Embolism / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010644:Phenprocoumon / Q000008:administration & dosage / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis*
D000925:Anticoagulants; D010644:Phenprocoumon