title: Anticoagulation Quality and Complications of using Vitamin K Antagonists in the Cardiac Surgery Outpatient Clinic.
abstract: In patients with mechanical prosthetic heart valves or atrial fibrillation requiring anticoagulation to prevent thromboembolic events, several factors influence adherence and anticoagulation complications.
  
  
  
  To evaluate the factors that interfere with the quality and complications of anticoagulation with vitamin K antagonists.
  
  
  
  A retrospective cohort study of 100 patients, in the period from 2011 to 2014, was performed. Anticoagulation conditions in the last year, regarding the presence of complications (embolisms/bleeding) and inadequate treatment were assessed: achievement of less than 8 annual prothrombin times and International Normalized Ratio outside therapeutic target in more than 40% of prothrombin times.
  
  
  
  There were 31 complications (22 minor bleeding without hospitalization and 9 major complications: 7 bleeding with hospitalization and two emboli); 70 were with International Normalized Ratio outside the target in more than 40% of the tests and 36 with insufficient number of prothrombin times. Socioeconomic factors, anticoagulant type and anticoagulation reason had no relationship with complications or with inadequate treatment. There were more complications in patients with longer duration of anticoagulation (P=0.001). Women had more International Normalized Ratio outside the target range (OR 2.61, CI:1.0-6.5; P=0.04). Patients with lower number of annual prothrombin times had longer times of anticoagulation (P=0.03), less annual consultations (P=0.02) and less dose adjustments (P=0.003). Patients with longer duration of anticoagulation have more complications (P=0.001).
  
  
  
  There was a high rate of major complications and International Normalized Ratio was outside the goal. Less annual prothrombin times was related to longer duration of anticoagulation, less annual consultations and less dose adjustments. More major complications occurred in patients with longer duration of anticoagulation.
authors.affiliation: Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa, PR, Brazil and Santa Casa de Misericórdia de Ponta Grossa, Ponta Grossa, PR, Brazil.
authors.forename: Mário Augusto Cray
authors.initials: MAC
authors.lastname: da Costa
authors.affiliation: Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa, PR, Brazil.
authors.forename: Lucas Kraeski
authors.initials: LK
authors.lastname: Krum
authors.affiliation: Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa, PR, Brazil.
authors.forename: Juliana da Silva
authors.initials: JD
authors.lastname: Geraldino
authors.affiliation: Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa, PR, Brazil.
authors.forename: Marcelo Derbli
authors.initials: MD
authors.lastname: Schafranski
authors.affiliation: Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa, PR, Brazil.
authors.forename: Ricardo Zanetti
authors.initials: RZ
authors.lastname: Gomes
authors.affiliation: Universidade Estadual de Ponta Grossa (UEPG), Ponta Grossa, PR, Brazil.
authors.forename: Elise Souza Dos Santos
authors.initials: ES
authors.lastname: Reis
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D000925:Anticoagulants / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000150:complications; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019934:International Normalized Ratio / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011517:Prothrombin Time / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013923:Thromboembolism / Q000150:complications / Q000209:etiology; D013997:Time Factors; D014812:Vitamin K / Q000009:adverse effects / Q000037:antagonists & inhibitors*; D014859:Warfarin / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D014859:Warfarin