Problems, interventions and complications in long-term oral anticoagulation therapy.
BACKGROUND
If problems, interventions and complications occurring during oral anticoagulation (OAC) are related with age, indication for OAC, hypertension, diabetes, previous stroke, and number of additional drugs.


METHODS
Clinical characteristics, additional drugs, problems, interventions and complications of outpatients whose OAC was controlled between two years were registered. Potential gastrointestinal and urologic bleeding sources were eliminated prior to initiation of OAC. Five-hundred-seventy-nine patients (mean age 65 years, 44% female) were observed for 590 patient-years.


RESULTS
Medical problems occurred in 352/100 patient-years (% p-y), organisational problems in 276% p-y, interventions in 636% p-y and complications in 13.8% p-y. Patients >65 years had less organisational problems (254 vs. 302% p-y, p = 0.0092) and interventions (574 vs. 713% p-y, p = 0.0003) than patients < or =65 years. The 35 patients with heart valve prosthesis had more life-threatening and fatal complications (12% p-y) than the 360 patients with atrial fibrillation (1.0% p-y), 128 patients with venous thromboembolism or 56 patients with other indications (0.0% p-y, p = 0.0024). Problems, interventions and complications were not related with hypertension (n = 297), diabetes (n = 97) or previous stroke (n = 90). Patients with >3 additional drugs/day had a higher complication rate than patients with < or =3 drugs/day (21 vs. 8.7% p-y, p = 0.0238). Patients with complications had more headache (27 vs. 20% p-y, p = 0.0036), chest pain (45 vs. 27% p-y, p = 0.0150), abdominal pain (25 vs. 15% p-y, p = 0.0350) and pain in the limbs (55 vs. 42% p-y, p = 0.0044) than patients without complications.


CONCLUSIONS
By careful monitoring, eliminating potential bleeding sources, treating pain adequately and minimizing additional drugs the complications of OAC can be kept low.
Stöllberger
Claudia
C
2nd Medical Department, KA Rudolfstiftung, Wien, Austria. claudia.stoellberger@chello.at
Finsterer
Josef
J
Länger
Thomas
T
Schneider
Barbara
B
Wehinger
Cornelius
C
Hopmeier
Pierre
P
Slany
Jörg
J
D000368:Aged; D000553:Ambulatory Care / Q000379:methods / Q000706:statistics & numerical data; D000704:Analysis of Variance; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D008134:Long-Term Care / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric; D013923:Thromboembolism / Q000139:chemically induced / Q000517:prevention & control
D000925:Anticoagulants