Dataset Information

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

ACCESS DATA

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]

PMID: 23620189

Similar Datasets

Project description:BACKGROUND:Forensic psychiatric patients are often diagnosed with psychiatric disorders characterized by high levels of impulsivity as well as comorbid substance use disorders (SUD). The combination of psychiatric disorders and SUD increases the risk of future violence. Chronic substance abuse can lead to a structural state of disinhibition, resulting in more drug taking and eventually loss of control over drug intake. When treating SUD, it is crucial to address high levels of impulsivity and lack of inhibitory control. OBJECTIVE:This study set out to investigate the effects of a theta/sensorimotor rhythm (SMR) neurofeedback training protocol on levels of impulsivity, levels of drug craving, and actual drug intake in a population of forensic psychiatric patients with a diagnosis of SUD. METHODS:A total of 21 participants received 20 sessions of theta/SMR neurofeedback training in combination with treatment-as-usual (TAU). Results of the intervention were compared with results from 21 participants who received TAU only. RESULTS:SMR magnitude showed a significant (P=.02) increase post training for patients in the neurofeedback training group, whereas theta magnitude did not change (P=.71). Levels of drug craving as well as scores on the motor subscale of the Barratt Impulsivity Scale-11 decreased equally for patients in the neurofeedback training group and the TAU group. Other measures of impulsivity as well as drug intake did not change posttreatment (P>.05). Therefore, neurofeedback+TAU was not more effective than TAU only. CONCLUSIONS:This study demonstrated evidence that forensic psychiatric patients are able to increase SMR magnitude over the course of neurofeedback training. However, at the group level, the increase in SMR activity was not related to any of the included impulsivity or drug craving measures. Further research should focus on which patients will be able to benefit from neurofeedback training at an early stage of the employed training sessions. TRIAL REGISTRATION:Dutch National Trial Register: NTR5386; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5386 (Archived by WebCite at http://www.webcitation.org/6nXLQuoLl).

Dataset Information

Identifying the risks of anticoagulation in patients with substance abuse.

Background

Objective

Design

Patients

Main measures

Results

Publications

Identifying the risks of anticoagulation in patients with substance abuse.

Similar Datasets

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