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Identifying the risks of anticoagulation in patients with substance abuse.


ABSTRACT:

Background

Warfarin is effective in preventing thromboembolic events, but concerns exist regarding its use in patients with substance abuse.

Objective

Identify which patients with substance abuse who receive warfarin are at risk for poor outcomes.

Design

Retrospective cohort study. Diagnostic codes, lab values, and other factors were examined to identify risk of adverse outcomes.

Patients

Veterans AffaiRs Study to Improve Anticoagulation (VARIA) database of 103,897 patients receiving warfarin across 100 sites.

Main measures

Outcomes included percent time in therapeutic range (TTR), a measure of anticoagulation control, and major hemorrhagic events by ICD-9 codes.

Results

Nonusers had a higher mean TTR (62 %) than those abusing alcohol (53 %), drugs (50 %), or both (44 %, p? 2.0) predicted progressively poorer anticoagulation control (49 % and 44 %, p?2.0 corresponded to more than three times the hemorrhages (HR 3.02, p?ConclusionsAnticoagulation control is particularly poor in patients with substance abuse. Major hemorrhages are more common in both alcohol and drug users. Among alcohol abusers, the ratio of AST/ALT holds promise for identifying those at highest risk for adverse events.

SUBMITTER: Efird LM 

PROVIDER: S-EPMC3785645 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Publications

Identifying the risks of anticoagulation in patients with substance abuse.

Efird Lydia M LM   Miller Donald R DR   Ash Arlene S AS   Berlowitz Dan R DR   Ozonoff Al A   Zhao Shibei S   Reisman Joel I JI   Jasuja Guneet K GK   Rose Adam J AJ  

Journal of general internal medicine 20130426 10


<h4>Background</h4>Warfarin is effective in preventing thromboembolic events, but concerns exist regarding its use in patients with substance abuse.<h4>Objective</h4>Identify which patients with substance abuse who receive warfarin are at risk for poor outcomes.<h4>Design</h4>Retrospective cohort study. Diagnostic codes, lab values, and other factors were examined to identify risk of adverse outcomes.<h4>Patients</h4>Veterans AffaiRs Study to Improve Anticoagulation (VARIA) database of 103,897 p  ...[more]

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