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Problems, Interventions and Complications in Long-Term Oral Anticoagulation Therapy

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Abstract

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.

Material and 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 ≤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 ≤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.

Abbreviated abstract. Aim of the study was to assess if problems, interventions and complications occurring during oral anticoagulation (OAC) in 579 outpatients (mean age 65 years, 44% female) are related with age, indication for OAC, cardiovascular risk factors and number of additional drugs. During 590 patient-years 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 ≤65 years. Patients with heart valve prosthesis had more life-threatening and fatal complications (12% p-y) than atrial fibrillation (1.0% p-y) or venous thromboembolism (p = 0.0024). Problems, interventions and complications were not related with cardiovascular risk factors. Patients with >3 additional drugs/day had a higher complication rate than patients with ≤3 drugs/day (21 vs. 8.7% p-y, p = 0.0294). By careful monitoring the complications of OAC can be kept low.

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Authors and Affiliations

  1. 2nd Medical Department, KA Rudolfstiftung, Wien, Austria

    Claudia Stöllberger, Cornelius Wehinger & Jörg Slany

  2. 2nd Neurological Department, Hospital Rosenhügel, Wien, Austria

    Josef Finsterer

  3. Austrian Research Centers Seibersdorf, Seibersdorf, Austria

    Thomas Länger

  4. Institut for Medical Statistics and Documentation, University of Vienna, Wien, Austria

    Barbara Schneider

  5. Central Laboratory, KA Rudolfstiftung, Wien, Austria

    Pierre Hopmeier

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  1. Claudia Stöllberger
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  7. Jörg Slany
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Stöllberger, C., Finsterer, J., Länger, T. et al. Problems, Interventions and Complications in Long-Term Oral Anticoagulation Therapy. J Thromb Thrombolysis 14, 65–72 (2002). https://doi.org/10.1023/A:1022070406307

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