warfarin and Cognition-Disorders

Warfarin embryopathy is a well-defined manifestation of intrauterine warfarin exposure. The embryopathy phenotype as it relates to the nervous system is broad and poorly recognised. We describe an adult with neurological sequelae of fetal warfarin exposure. We review previous cases with neurological sequelae and discuss the pathogenetic mechanism in light of recent research.

Topics: Abnormalities, Drug-Induced; Adult; Anticoagulants; Cognition Disorders; Deafness; Humans; Male; Nasal Bone; Spinal Cord Diseases; Spine; Warfarin

Atrial fibrillation is associated with decline of cognitive function. Observational evidence suggests that anticoagulation might protect against this decline. We report the first randomized controlled trial evidence on the effect of anticoagulation on cognitive function in elderly patients with atrial fibrillation.. A total of 973 patients aged≥75 years with atrial fibrillation were recruited from primary care and randomly assigned to warfarin (n=488; target international normalized ratio, 2-3) or aspirin (n=485; 75 mg/d). Neither participants nor investigators were masked to group assignment. Follow-up was for a mean of 2.7 years (SD, 1.2). Cognitive outcome was assessed using the Mini-Mental State Examination at 9-, 21-, and 33-month follow-up. Participants who had a stroke were censored from the analysis, which was by intention to treat with imputation for missing data.. There was no difference between mean Mini-Mental State Examination scores in people assigned to warfarin or aspirin at 9 or 21 months. At 33-month follow-up, there was a nonsignificant difference of 0.56 in favor of warfarin that decreased to 0.49 (95% confidence interval, -0.01 to 0.98) after imputation.. We found no evidence that anticoagulation confers clinically important protection over aspirin against cognitive decline as measured by the Mini-Mental State Examination in atrial fibrillation in the first 33 months of treatment other than that provided by preventing clinical stroke.. http://www.controlled-trials.com. Unique identifier: ISRCTN89345269.

Topics: Aged; Aged, 80 and over; Aging; Anticoagulants; Aspirin; Atrial Fibrillation; Cognition Disorders; Female; Fibrinolytic Agents; Follow-Up Studies; Humans; Male; Time Factors; Treatment Outcome; Warfarin

To explore whether antithrombotic medication may protect against cognitive decline, tests of verbal memory, attention, abstract reasoning, verbal fluency, and mental flexibility were administered to 405 men at risk of cardiovascular disease. These subjects were a subgroup of those who had been participating in a randomised double blind factorial trial of low dose aspirin (75 mg daily) and low intensity oral anticoagulation with warfarin (international normalised ratio of 1.5) at 35 general practices across the United Kingdom for at least five years, were at least 55 years old at trial entry, and had been randomly allocated to one of four groups: active warfarin and active aspirin, active warfarin and placebo aspirin, placebo warfarin and active aspirin, and double placebo. Verbal fluency and mental flexibility were significantly better in subjects taking antithrombotic medication than in subjects taking placebo. Aspirin may have contributed more than warfarin to any beneficial effect. These results provide tentative evidence that antithrombotic medication may protect cognitive function in men at risk of cardiovascular disease.

Topics: Aged; Anticoagulants; Aspirin; Cardiovascular Diseases; Cognition; Cognition Disorders; Double-Blind Method; Humans; Male; Middle Aged; Multivariate Analysis; Neuropsychological Tests; Platelet Aggregation Inhibitors; Risk Factors; Warfarin

Nowadays, anticoagulant therapy belongs to the most commonly used forms of pharmacotherapy in modern medicine. The most important representatives of anticoagulants are heparins (unfractionated heparin and low-molecular-weight heparin) and coumarin derivatives (vitamin K antagonists--VKA). Next to the many advantages of traditional oral anticoagulants may also have disadvantages. In Poland most often used two VKA: acenocoumarol and warfarin. The aim of the work is the analysis of the causes of the occurrence of bleeding disorders and symptoms of overdose VKA in patients to be hospitalized. In the years 2012 to 2014 were hospitalized 62 patients with overdose VKA (40 women and 22 men). The average age of patients was 75.3 years) and clotting disturbances and/or bleeding. At the time of the admission in all patients a significant increase in the value of the INR was stated, in 22 patients INR result was " no clot detected", on the remaining value of the INR were in the range of 7 to 13.1. On 51 patients observed different severe symptoms of bleeding (hematuria, bleeding from mucous membranes of the nose or gums ecchymoses on the extremities, bleeding from the gastrointestinal tract--as in 5 patients has led to significant anemia and transfusion of concentrated red blood cells. Up on 33 patients kidney function disorder were found--exacerbated chronic renal failure and urinary tract infection. 8 diagnosed inflammatory changes in the airways. On 13 patients, it was found a significant degree of neuropsychiatric disorders (dementia, cognitive impairment), which made impossible the understanding the sense of treatment and cooperation with the patient. In 6 patients the symptoms of overdose were probably dependent on the interaction with the congestants at the same time (change the preparation of anticoagulant, NSAIDs, antibiotics). In 2 cases, the overdose was a suicide attempt in nature. In addition to the above mentioned disorders, on two of those patients diagnosed with a malignant disease. Two patients died, the other has been improving and anticoagulant therapy with VKA was continued, in 4 VKA were changed to low-molecular-weight heparin, and on 4 commissioned new generation anticoagulant (rivaroxaban).

Topics: Acenocoumarol; Aged; Aged, 80 and over; Anticoagulants; Cognition Disorders; Dementia; Drug Interactions; Drug Overdose; Female; Humans; Male; Neoplasms; Poland; Suicide, Attempted; Vitamin K; Warfarin

Topics: Anticoagulants; Aspirin; Atrial Fibrillation; Cognition Disorders; Female; Fibrinolytic Agents; Humans; Male; Warfarin

Topics: Anticoagulants; Aspirin; Atrial Fibrillation; Cognition Disorders; Female; Fibrinolytic Agents; Humans; Male; Warfarin

Despite guidelines that clearly outline the benefits of warfarin, it remains underutilized. Various reasons are associated with the underuse of warfarin; however, cognitive impairment (CI) has been identified as one of the most common causes for not electing to anticoagulate elderly patients with atrial fibrillation. Nevertheless, there are limited data on warfarin use in such patients; therefore, we investigated anticoagulation stability in patients with and without CI.. Our objectives were to (i) examine if mild to moderate CI delayed the time required to achieve initial therapeutic anticoagulation; (ii) determine if mild to moderate CI was associated with long-term anticoagulation instability; and (iii) assess if initial anticoagulation problems predicted long-term anticoagulation instability.. A retrospective study in a pharmacist-managed anticoagulation clinic was conducted in community-dwelling patients ≥60 years of age on warfarin therapy with a target international normalized ratio (INR) of 2.0-3.0. Our study included 57 patients; 20 were initiated on warfarin and 54 were analysed for long-term anticoagulation stability. Age, ethnicity, gender, warfarin indication, co-morbidities and caregiver involvement were recorded. We defined CI as having a Mini-Mental State Examination (MMSE) score of ≤26. To evaluate initial anticoagulation stability between groups, we analysed (i) number of clinic visits and days to achieve therapeutic INR; and (ii) minor and major adverse events upon initiation of warfarin. To evaluate long-term anticoagulation stability, we analysed (i) time in therapeutic range (TTR); (ii) the percentage of clinic visits with a reported dose mishap and the frequency of out-of-range INRs resulting from dose mishaps; and (iii) parameters associated with the intensity of clinic management: weekly warfarin dose changes, transient dose adjustments, any dose manipulation and the length of time between clinic visits.. We found no difference in the number (mean ± SD) of visits (control = 5.8 ± 4.3, CI = 4.6 ± 2.4; p = 0.44) or days (control = 51.6 ± 45.7, CI = 35.8 ± 30.5; p = 0.36) required to achieve initial therapeutic anticoagulation. No adverse effects were reported in either group. In terms of long-term stability, TTR (mean ± SD) was similar for both groups (control = 65 ± 20% vs CI = 61 ± 16%; p = 0.36). Although the proportion of dose mishaps did not differ (control = 74 in 705 visits, CI = 86 in 691 visits; p = 0.18), dose mishaps resulted in a greater frequency of out-of-range INRs for patients with CI (p = 0.01). There were no differences in clinic management measures between groups (p = not statistically significant [NS] for all). Finally, we found no correlation between the time to reach initial anticoagulation stability and long-term stability for either group (p = NS for all).. We found mild to moderate CI neither delayed the time required to achieve therapeutic anticoagulation, nor decreased anticoagulation stability versus patients with normal cognitive function. Additionally, CI did not require more intensive clinic management. CI should not necessarily be a barrier to the use of warfarin anticoagulation in elderly patients attending an anticoagulation clinic.

Topics: Aged; Aged, 80 and over; Anticoagulants; Cognition Disorders; Drug Monitoring; Female; Humans; Male; Retrospective Studies; Time Factors; Treatment Outcome; Warfarin

Atrial fibrillation (AF), in addition to macroembolic complications, may also produce multiple cerebral ischemic areas due to microembolic phenomena and transient hypoperfusion, eventually leading to a progressive cognitive impairment and even to acclaimed vascular dementia. The aim of this study was to evaluate the prevalence of cognitive impairment in patients with AF. The reported results concern data obtained at the moment of recruitment.. The authors studied 42 patients with a history of non valvular AF (paroxysmal, persistent, recurrent or permanent) and 40 homogenous controls in sinus rhythm without previous AF. All subjects underwent anamnesis, physical examination, biochemical and instrumental tests. To investigate the cognitive status, subjects underwent the following neuropsychological rating scales: Mini Mental State Examination (MMSE), Clinical Dementia Rating Scale (CDR),Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL) Global Deterioration Scale (GLDS), Geriatric Depression Scale (GDS) and Hachinski Ischemic Score (HIS).. AF Patients had worse scores versus controls at GLDS (P=0.0001), HIS (P=0.001), CDR (P=0.07) and GDS (P=0.07); no significant differences were found for MMSE even after correction for age and education. AF patients treated with warfarin showed better scores at CDR (P=0.04),GLDS (P=0.03) and GDS (P=0.007), compared to those in aspirin-treatment. Corrected MMSE scores did not differ.. The authors identified a slight cognitive impairment in the AF group; patients with paroxysmal, persistent or recurrent AF showed worse cognitive performances than permanent ones, suggesting a possible microembolic pathogenesis. Anticoagulation therapy could play a protective role, however more evidence is needed.

Topics: Activities of Daily Living; Aged; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Aspirin; Atrial Fibrillation; Case-Control Studies; Cognition Disorders; Disability Evaluation; Drug Therapy, Combination; Electrocardiography; Female; Humans; Male; Middle Aged; Neuropsychological Tests; Prevalence; Psychiatric Status Rating Scales; Research Design; Risk Factors; Sicily; Treatment Outcome; Warfarin

Susac's syndrome is a rare disease of unknown aetiology affecting the small vessels of the retina, brain, and cochlea. We present the case of a 55-year-old female, the oldest patient yet described with the condition, and highlight the syndrome's clinical features.

Topics: Anti-Inflammatory Agents; Anticoagulants; Cerebral Angiography; Cerebrovascular Disorders; Cochlear Diseases; Cognition Disorders; Female; Hearing Disorders; Humans; Methylprednisolone; Middle Aged; Retinal Diseases; Syndrome; Warfarin

To identify the current state of medication-taking practices of community-dwelling older adults on high-risk medications.. Telephone survey of older adults filling prescriptions for warfarin, digoxin, or phenytoin from May 2, 2002, through June 30, 2003.. The Pennsylvania Pharmacy Assistance Contract for the Elderly (PACE) Program, a state-run program providing prescription drug coverage for poor older adults.. PACE members.. Patients self-reported sources of information on current medications as well as home-based practices for organizing medication regimens.. Four thousand nine hundred fifty-five PACE members were interviewed. Thirty-two percent of the sample reported that they had not received any specific instructions about their medications, 35% reported that they received instructions from their primary care provider, and 46% indicated they received them from a pharmacist. Fifty-four percent of participants indicated that they used a pillbox for organizing their medications. Older adults prescribed warfarin were more likely to report receiving instructions than those prescribed digoxin or phenytoin.. A substantial proportion of older adults on high-risk medications do not recall receiving instructions for the use of their medications and do not take advantage of existing systems for organizing medication regimens. Improved patient education and delivery of medication organization systems are immediate opportunities to potentially reduce the risk of medication errors in older people.

Topics: Aged; Aged, 80 and over; Cognition Disorders; Cohort Studies; Digoxin; Female; Health Behavior; Health Services Accessibility; Health Status; Home Nursing; Humans; Male; Medication Errors; Patient Education as Topic; Pennsylvania; Phenytoin; Population Surveillance; Prospective Studies; Self Administration; Warfarin

To evaluate a clinical practice model that addresses special needs for managing anticoagulation in a community-dwelling elderly population with atrial fibrillation and high risk of stroke.. Medical records of 18 patients (mean age 82 y) followed by the Geriatric Ambulatory Program over 2 years, with a target international normalized ratio (INR) of 2.0-3.0, were reviewed. Risk factors for stroke, number and results of INR tests, suspected reasons for suboptimal response, and adverse events were analyzed. Patients were defined as having cognitive impairment if they had a Folstein Mini-Mental State Exam score < or = 26. Functional impairment was defined by > or = 2 disabilities in activities of daily living.. Eighty-three percent (15/18) had > or = 2 additional stroke risk factors. Fifty-one percent (273/541) of INR responses were therapeutic. Female gender (p = 0.015) and cognitive (p = 0.019) and functional impairment (p = 0.001) were associated with supratherapeutic INR response. All patients with cognitive impairment and 85% of those with functional impairment received caregiver support for medication administration. There were 4 minor bleeding events and no thromboembolic events. The mean number of medications was 9.3 in those with bleeding versus 6.8 in those without bleeding (p = 0.052).. Elderly patients with high stroke risk achieved therapeutic INR responses. However, those with significant cognitive or functional impairment require caregiver support and special consideration for anticoagulation management.

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Blood Coagulation; Cognition Disorders; Female; Hemorrhage; Humans; International Normalized Ratio; Male; Middle Aged; Stroke; Warfarin

Stroke incidence increases with age, and stroke survivors often require nursing home placement. Characteristics of these residents and factors associated with the secondary drug prevention of stroke in nursing homes have yet to be explored.. We used a population-based data set of all nursing home residents in 5 states (1992 to 1995). We identified 53 829 (20.4%) with a diagnosis of stroke on the Minimum Data Set assessment. We considered aspirin, dipyridamole, ticlopidine, or warfarin alone or in combination as secondary drug prevention. We used logistic regression modeling to identify independent predictors of drug treatment.. Sixty-seven percent of stroke survivors were not receiving drug therapy for stroke prevention. Among those treated, most received aspirin alone (16%) or warfarin alone (10%). Independent predictors of drug treatment included comorbid conditions (eg, hypertension, atrial fibrillation, depression, Alzheimer's disease, dementia, gastrointestinal bleeding, and peptic ulcer disease). Those over the age of 85 years were less likely to be treated than those 65 to 74 years of age (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.82 to 0.91); black residents were less likely to be treated than whites (OR, 0.80; 95% CI, 0.75 to 0.85); and those with severe cognitive (OR, 0.63; 95% CI, 0.60 to 0.67) or physical impairment (OR, 0.69; 95% CI, 0.64 to 0.75) were also less likely to receive drug treatment.. Stroke is highly prevalent in long-term care. Despite the increased risk of subsequent stroke in the elderly, many are not being treated. The choice to treat or not to treat may be influenced by age, comorbidity, race/ethnicity, and cognitive or physical functioning.

Topics: Aged; Aged, 80 and over; Aspirin; Cognition Disorders; Comorbidity; Cross-Sectional Studies; Databases, Factual; Dipyridamole; Drug Therapy, Combination; Female; Humans; Inpatients; Logistic Models; Long-Term Care; Male; Nursing Homes; Odds Ratio; Prevalence; Risk Assessment; Risk Factors; Severity of Illness Index; Stroke; Ticlopidine; United States; Warfarin

Topics: Aged; Atrial Fibrillation; Cerebral Infarction; Cognition Disorders; Humans; Warfarin