warfarin and Alcoholism

Topics: Acetaminophen; Alcoholism; Animals; Antipyrine; Aryl Hydrocarbon Hydroxylases; Electron Transport; Energy Intake; Enzyme Induction; Epilepsy; Female; Humans; Male; Microsomes, Liver; Pharmacology; Phenobarbital; Phenylbutazone; Phenytoin; Smoking; Tolbutamide; Warfarin

Topics: Abnormalities, Drug-Induced; Alcoholic Intoxication; Alcoholism; Anticonvulsants; Contraceptives, Oral; Environmental Exposure; Epilepsy; Female; Folic Acid Deficiency; Gonadal Steroid Hormones; Humans; Lysergic Acid Diethylamide; Operating Rooms; Plant Diseases; Pregnancy; Pregnancy Tests; Teratogens; Warfarin; Water Softening

Topics: Alcoholism; Clinical Trials as Topic; Ethanol; Humans; Liver; Microsomes; Phenytoin; Tolbutamide; Warfarin

To investigate risk factors for severe bleeding during warfarin treatment, including the influence of sex, age, comorbidity and co-medication on bleeding risk.. Patients initiating warfarin treatment between 2007 and 2011 were identified in the nationwide Swedish Prescribed Drug Register, and diagnoses of severe bleeding were retrieved from the National Patient Register. Hazard ratios (HR) with 95% confidence intervals (CI) for severe bleeding were estimated using multiple Cox regression adjusting for indications and including covariates age, sex, comorbidities and co-medications. Interactions between sex and other covariates were investigated.. The study cohort included 232,624 patients ≥ 18 years (101,011 women and 131,613 men). The incidence rate of severe bleeding was 37 per 1000 person-years, lower among women than men with an adjusted HR (95% CI) of 0.84 (0.80-0.88). Incidence of bleeding increased with age, HR 2.88 (2.37-3.50) comparing age ≥ 80 to < 40 years, and comorbidities associated with the highest risk of severe bleeding were prior bleeding, HR 1.85 (1.74-1.97); renal failure, HR 1.82 (1.66-2.00); and alcohol dependency diagnosis, HR 1.79 (1.57-2.05). Other comorbidities significantly associated with bleeding events were hypertension, diabetes, peripheral vascular disease, congestive heart failure, liver failure, stroke/TIA, COPD and cancer.. Most of the well-established risk factors were found to be significantly associated with bleeding events in our study. We additionally found that women had a lower incidence of bleeding. Potential biases are selection effects, residual confounding and unmeasured frailty.

Topics: Adult; Aged; Aged, 80 and over; Alcoholism; Anticoagulants; Atrial Fibrillation; Comorbidity; Female; Hemorrhage; Humans; Male; Middle Aged; Renal Insufficiency; Risk Factors; Warfarin

Guidelines recommend oral anticoagulation for ischemic stroke patients with atrial fibrillation, and previous studies have shown the underuse of anticoagulation for these patients in China. We sought to explore the underlying reasons and factors that currently affect the use of warfarin in China.. From June 2012 to January 2013, 19 604 patients with acute ischemic stroke were admitted to 219 urban hospitals voluntarily participating in the China National Stroke Registry II. Multivariable logistic regression models using the generalized estimating equation method were used to identify patient/hospital factors independently associated with warfarin use at discharge.. Among the 952 acute ischemic stroke patients with nonvalvular atrial fibrillation, 19.4% were discharged on warfarin. The risk of bleeding (52.8%) and patient refusal (31.9%) were the main reasons for not prescribing anticoagulation. Larger/teaching hospitals were more likely to prescribe warfarin. Older patients, heavy drinkers, patients with higher National Institutes of Health Stroke Scale score on admission were less likely to be given warfarin, whereas patients with history of heart failure and an international normalized ratio between 2.0 and 3.0 during hospitalization were significantly associated with warfarin use at discharge.. The rate of warfarin use remains low among patients with ischemic stroke and known nonvalvular atrial fibrillation in China. Hospital size and academic status together with patient age, heart failure, heavy alcohol drinking, international normalized ratio in hospital, and stroke severity on admission were each independently associated with the use of warfarin at discharge. There is much room for improvement for secondary stroke prevention in nonvalvular atrial fibrillation patients in China.

Topics: Age Factors; Aged; Aged, 80 and over; Alcohol Drinking; Alcoholism; Anticoagulants; Atrial Fibrillation; China; Female; Guideline Adherence; Health Facility Size; Hemorrhage; Hospitals, Teaching; Humans; International Normalized Ratio; Logistic Models; Male; Middle Aged; Multivariate Analysis; Patient Discharge; Practice Guidelines as Topic; Practice Patterns, Physicians'; Prospective Studies; Registries; Risk; Risk Factors; Secondary Prevention; Severity of Illness Index; Stroke; Treatment Refusal; Warfarin

Little is known about the impact of alcohol consumption on warfarin safety, or whether demographic, clinical, or genetic factors modify risk of adverse events. We conducted a case-control study to assess the association between screening positive for moderate/severe alcohol misuse and the risk of major bleeding in a community sample of patients using warfarin.. The study sample consisted of 570 adult patients continuously enrolled in Group Heath for at least 2 years and receiving warfarin. The main outcome was major bleeding validated through medical record review. Cases experienced major bleeding, and controls did not experience major bleeding. Exposures were Alcohol Use Disorders Identification Test Consumption Questionnaire (AUDIT-C) scores and report of heavy episodic drinking (≥5 drinks on an occasion). The odds of major bleeding were estimated with multivariate logistic regression models. The overall sample was 55% male, 94% Caucasian, and had a mean age of 70 years.. Among 265 cases and 305 controls, AUDIT-C scores indicative of moderate/severe alcohol misuse and heavy episodic drinking were associated with increased risk of major bleeding (OR = 2.10, 95% CI = 1.08-4.07; and OR = 2.36, 95% CI = 1.24-4.50, respectively). Stratified analyses demonstrated increased alcohol-related major bleeding risk in patients on warfarin for ≥1 year and in those with a low-dose genotype (CYP2C9*2/*3, VKORC1(1173G>A), CYP4F2*1), but not in other sub-groups evaluated.. Alcohol screening questionnaires, potentially coupled with genetic testing, could have clinical utility in selecting patients for warfarin therapy, as well as refining dosing and monitoring practices.

Topics: Aged; Alcoholism; Anticoagulants; Case-Control Studies; Community Health Services; Cytochrome P-450 Enzyme System; Female; Hemorrhage; Humans; Idaho; Logistic Models; Male; Surveys and Questionnaires; Warfarin; Washington

To characterize warfarin eligibility and receipt among Veterans Health Administration (VHA) patients with and without mental health conditions (MHCs).. Retrospective cohort study.. This observational study identified VHA atrial fibrillation (AF) patients with and without MHCs in 2004. We examined unadjusted MHC-related differences in warfarin eligibility and warfarin receipt among warfarin-eligible patients, using logistic regression for any MHC and for specific MHCs (adjusting for sociodemographic and clinical characteristics).. Of 125,670 patients with AF, most (96.8%) were warfarin-eligible based on a CHADS2 stroke risk score. High stroke risk and contraindications to anticoagulation were both more common in patients with MHC. Warfarin-eligible patients with MHC were less likely to receive warfarin than those without MHC (adjusted odds ratio [AOR], 0.90; 95% CI, 0.87-0.94). The association between MHC and warfarin receipt among warfarin-eligible patients varied by specific MHC. Patients with anxiety disorders (AOR, 0.86; 95% CI, 0.80-0.93), psychotic disorders (AOR, 0.77; 95% CI, 0.65-0.90), and alcohol use disorders (AOR 0.62, 95% CI 0.54-0.72) were less likely to receive warfarin than patients without these conditions, whereas patients with depressive disorders and posttraumatic stress disorder were no less likely to receive warfarin than patients without these conditions.. Compared with patients with AF without MHCs, those with MHCs are less likely to be eligible for warfarin receipt and, among those eligible, are less likely to receive such treatment. Although patients with AF with MHC need careful assessment of bleeding risk, this finding suggests potential missed opportunities for more intensive therapy among some individuals with MHCs.

Topics: Aged; Alcoholism; Anticoagulants; Anxiety Disorders; Atrial Fibrillation; Depressive Disorder; Female; Humans; Male; Mental Disorders; Middle Aged; Psychotic Disorders; Retrospective Studies; Stress Disorders, Post-Traumatic; Warfarin

While a considerable amount is known about which patient-level factors predict poor anticoagulation control with warfarin, measured by percent time in therapeutic range (TTR), less is known about predictors of time above or below target.. To identify predictors of different patterns of international normalized ratio (INR) values that account for poor control, including 'erratic' patterns, where more time is spent both above and below INR target, and unidirectional patterns, where time out of range is predominantly in one direction (low or high).. We studied 103 897 patients receiving warfarin with a target INR of 2-3 from 100 Veterans Health Administration sites between October 2006 and September 2008. Our outcomes were percent time above and below the target range. Predictors included patients' demographics, comorbidities, and other clinical data.. Predictors of erratic patterns included alcohol abuse (5.2% more time below and 3.7% more time above, P < 0.001 for all results), taking > 16 medications (4.6% more time below and 1.8% more time above compared to taking seven or fewer medications), and four or more hospitalizations during the study (6.6% more time below and 2% more time above compared to no hospitalization). In contrast, predictors like cancer, non-alcohol drug abuse, dementia, and bipolar disorder were associated with more time below the target range (3.4%, 5.2%, 2.6%, and 3.2%, respectively) and less (or similar) time above range.. Different patient-level factors predicted unidirectional below-target and 'erratic' patterns of INR control. Distinct interventions are necessary to address these two separate pathways to poor anticoagulation.

Topics: Adult; Aged; Alcoholism; Anticoagulants; Atrial Fibrillation; Bipolar Disorder; Blood Coagulation; Dementia; Female; Hospitalization; Humans; International Normalized Ratio; Male; Middle Aged; Multivariate Analysis; Neoplasms; Substance-Related Disorders; Time Factors; Treatment Outcome; United States; United States Department of Veterans Affairs; Venous Thromboembolism; Warfarin; Young Adult

Warfarin is effective in preventing thromboembolic events, but concerns exist regarding its use in patients with substance abuse.. Identify which patients with substance abuse who receive warfarin are at risk for poor outcomes.. Retrospective cohort study. Diagnostic codes, lab values, and other factors were examined to identify risk of adverse outcomes.. Veterans AffaiRs Study to Improve Anticoagulation (VARIA) database of 103,897 patients receiving warfarin across 100 sites.. Outcomes included percent time in therapeutic range (TTR), a measure of anticoagulation control, and major hemorrhagic events by ICD-9 codes.. Nonusers had a higher mean TTR (62 %) than those abusing alcohol (53 %), drugs (50 %), or both (44 %, p < 0.001). Among alcohol abusers, an increasing ratio of the serum hepatic transaminases aspartate aminotransferase/alanine aminotransferase (AST:ALT) correlated with inferior anticoagulation control; normal AST:ALT ≤ 1.5 predicted relatively modest decline in TTR (54 %, p < 0.001), while elevated ratios (AST:ALT 1.50-2.0 and > 2.0) predicted progressively poorer anticoagulation control (49 % and 44 %, p < 0.001 compared to nonusers). Age-adjusted hazard ratio for major hemorrhage was 1.93 in drug and 1.37 in alcohol abuse (p < 0.001 compared to nonusers), and remained significant after also controlling for anticoagulation control and other bleeding risk factors (1.69 p < 0.001 and 1.22 p = 0.003). Among alcohol abusers, elevated AST:ALT >2.0 corresponded to more than three times the hemorrhages (HR 3.02, p < 0.001 compared to nonusers), while a normal ratio AST:ALT ≤ 1.5 predicted a rate similar to nonusers (HR 1.19, p < 0.05).. Anticoagulation 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.

Topics: Aged; Alcoholism; Anticoagulants; Comorbidity; Databases, Factual; Drug Administration Schedule; Female; Hemorrhage; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Substance-Related Disorders; United States; Veterans; Veterans Health; Warfarin

Calciphylaxis is a rare complication that occurs in 1% of patients with end-stage renal disease (ESRD) each year. Extensive microvascular calcification and occlusion/thrombosis lead to violaceous skin lesions, which progress to nonhealing ulcers with secondary infection, often leading to sepsis and death. The lower extremities are predominantly involved (roughly 90% of patients). Although most calciphylaxis patients have abnormalities of the calcium-phosphate axis or elevated levels of parathyroid hormone, these abnormalities do not appear to be fundamental to the pathophysiology of the disorder. We report on a case of histologically proven calciphylaxis in a 54-year-old woman with normal renal function and normal calcium-parathyroid homeostasis. She had a history of alcoholic cardiomyopathy, and was treated with warfarin anticoagulation. She has been successfully treated with antibiotics, i.v. biophosphonates and intensive local wound care. We recorded a complete wound healing in contrast to what is reported in other series.

Topics: Alcoholism; Anti-Bacterial Agents; Anticoagulants; Calciphylaxis; Clindamycin; Diphosphonates; Female; Heart Diseases; Humans; Kidney Failure, Chronic; Meropenem; Middle Aged; Risk Factors; Thienamycins; Vancomycin; Warfarin

To determine the incidence of major hemorrhage among outpatients started on warfarin therapy after the recommendation in 1986 for reduced-intensity anticoagulation therapy was made, and to identify baseline patient characteristics that predict those patients who will have a major hemorrhage.. Retrospective cohort study.. A university-affiliated Veterans Affairs Medical Center.. Five hundred seventy-nine patients who were discharged from the hospital after being started on warfarin therapy.. The primary outcome variable was major hemorrhage. In our cohort of 579 patients, there were 40 first-time major hemorrhages with only one fatal bleed. The cumulative incidence was 7% at 1 year. The average monthly incidence of major hemorrhage was 0.82% during the first 3 months of treatment and decreased to 0.36% thereafter. Three independent predictors of major hemorrhage were identified: a history of alcohol abuse, chronic renal insufficiency, and a previous gastrointestinal bleed. Age, comorbidities, medications known to influence prothrombin levels, and baseline laboratory values were not associated with major hemorrhage.. The incidence of major hemorrhage in this population of outpatients treated with warfarin was lower than previous estimates of major hemorrhage measured before the recommendation for reduced-intensity anticoagulation therapy was made, but still higher than estimates reported from clinical trials. Alcohol abuse, chronic renal insufficiency, and a previous gastrointestinal bleed were associated with increased risk of major hemorrhage.

Topics: Aged; Alcoholism; Ambulatory Care; Anticoagulants; Cohort Studies; Female; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Incidence; Kidney Failure, Chronic; Male; Retrospective Studies; Risk Factors; Warfarin

There is evidence that vitamin K-deficiency during human pregnancy can be caused by the therapeutic use of warfarin or phenytoin. The pregnancy histories of three cases of Binder's syndrome are reported. One was associated with warfarin exposure, one with phenytoin exposure and one with alcohol abuse. It is proposed that Binder's syndrome can be caused by prenatal exposure to agents that cause vitamin K-deficiency. Sprague-Dawley rats were treated from postnatal day 1 to 12 weeks with daily doses of warfarin (100 mg/kg) and concurrent vitamin K1 (10 mg/kg). This regimen creates a net extra-hepatic vitamin K-deficiency. The treated rats developed with a distinct facial appearance characterized by a markedly reduced snout. Histological examination showed that the normally non-calcified septal cartilage was extensively calcified. It is proposed that normal growth of the septal cartilage is necessary for the development of the profile of the nose and midface and that normal growth will only take place while the septal cartilage is uncalcified.

Topics: Adolescent; Alcoholism; Aneurysm, Ruptured; Animals; Cartilage; Child, Preschool; Female; Humans; Infant; Intracranial Aneurysm; Male; Maxilla; Nasal Bone; Nasal Septum; Phenytoin; Pregnancy; Pregnancy Complications, Cardiovascular; Prenatal Exposure Delayed Effects; Rats; Rats, Sprague-Dawley; Thrombophlebitis; Vitamin K; Vitamin K Deficiency; Warfarin

We investigated incidence, age distribution in relation to etiology, and localization of spontaneous intracerebral hematoma in 100 consecutive cases. Incidence in the total population of the Giessen area was estimated to be greater than 11/100,000 inhabitants/yr and increased with age. There was a trend toward higher incidence in males. Overall mortality was 27%, 22% of 58 patients aged less than 70 years and 33% of 42 patients aged greater than or equal to 70 years. Hypertensive putaminal hematoma showed the highest mortality rate (42%, 10 of 24 cases). Chronic alcoholism and anticoagulant medication influenced the mortality rate unfavourably. We found the following localizations and etiologies to have a specific relation with age: 1) lobar hematomas from vascular malformations, group aged less than 40 years; 2) hypertensive putaminal hematomas and hypertensive thalamic hematomas, group aged 40-69 years; and 3) lobar hematomas, group aged greater than or equal to 70 years. Alcoholism was an additional factor in 38% of the 13 middle-aged men with hypertensive putaminal hematomas. Fourteen cases of spontaneous intracerebral hematoma were possibly due to cerebral amyloid angiopathy. Six of these 14 patients had recurrent lobar hematomas, but only three of the six could be histologically investigated. In these three cases, cerebral amyloid angiopathy was proven.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Alcoholism; Cerebral Hemorrhage; Female; Germany; Hematoma; Humans; Hypertension; Incidence; Male; Middle Aged; Sex Characteristics; Warfarin

Topics: Alcoholism; Anesthetics; Anti-Anxiety Agents; Anticonvulsants; Antidepressive Agents; Antihypertensive Agents; Antipsychotic Agents; Aspirin; Disulfiram; Drug Interactions; Ethanol; Ethylene Dibromide; Hemorrhage; Humans; Hypoglycemia; Hypotension; Methotrexate; Narcotics; Procarbazine; Sulfonylurea Compounds; Warfarin

Topics: Abnormalities, Drug-Induced; Alcoholism; Chondrodysplasia Punctata; Diazepam; Digitalis Glycosides; Erythromycin; Female; Fetus; Heart Valve Prosthesis; Heparin; Humans; Infant, Newborn; Penicillin G Benzathine; Pregnancy; Pregnancy Complications; Sulfisoxazole; Syphilis; Thrombosis; Warfarin

Topics: Abnormalities, Drug-Induced; Alcoholism; Cerebrovascular Disorders; Chondrodysplasia Punctata; Contraceptives, Oral; Diazepam; Female; Fetus; Furosemide; Humans; Hypertension; Infant, Newborn; Male; Pregnancy; Pregnancy Complications; Radiography; Rheumatic Heart Disease; Stress, Psychological; Warfarin

Topics: Adult; Aged; Alcoholism; Evaluation Studies as Topic; Fatty Liver; Female; Hemorrhage; Humans; Hypoprothrombinemias; Liver Cirrhosis; Male; Middle Aged; Prospective Studies; Prothrombin; Prothrombin Time; Vitamin K Deficiency; Warfarin

Topics: Aged; Alcoholism; Allopurinol; Arrhythmias, Cardiac; Chloral Hydrate; Colchicine; Digoxin; Drug Synergism; Gastrointestinal Hemorrhage; Gout; Hospitals, Teaching; Humans; Liver Diseases; Male; Middle Aged; Nitroglycerin; Patient Care Team; Pharmacists; Pharmacy Service, Hospital; Quinidine; Warfarin; Washington

Topics: Alcoholism; Disulfiram; Drug Synergism; Humans; Male; Middle Aged; Warfarin

Topics: Alcoholism; Aortic Valve Insufficiency; Disulfiram; Drug Synergism; Humans; Male; Middle Aged; Warfarin