warfarin and Lung-Diseases--Obstructive

Topics: Anticoagulants; Asthma; Humans; Leukotriene Antagonists; Lung Diseases, Obstructive; Osteoporosis; Smoking Cessation; Smoking Prevention; Steroids; Warfarin

The value of warfarin in preventing stroke in patients with chronic atrial fibrillation is well established. However, the prevalence of such treatment generally lags behind actual requirements. The aim of this study was to evaluate doctor- and/or patient-related demographic, clinical, and echocardiographic factors that influence decision for warfarin treatment.. Between 1990 and 1998, 1027 patients were discharged with chronic or persistent atrial fibrillation. This population was composed of (1) patients with cardiac prosthetic valves (n=48), (2) those with increased bleeding risks (n=152), (3) physically or mentally handicapped patients (n=317), and (4) the remaining 510 patients, the main study group who were subjected to thorough statistical analysis for determining factors influencing warfarin use.. The respective rates of warfarin use on discharge in the 4 groups were 93.7%, 30.9%, 17.03%, and 59.4% (P=0.001); of the latter, an additional 28.7% were discharged on aspirin. In the main study group, warfarin treatment rates increased with each consecutive triennial period (29.7%, 53.6%, and 77.1%, respectively; P=0.001). Age >80 years, poor command of Hebrew, and being hospitalized in a given medical department emerged as independent variables negatively influencing warfarin use: P=0.0001, OR 0.30 (95% CI 0.17 to 0.55); P=0.02, OR 0.59 (95% CI 0.36 to 0.94); and P=0.0002, OR 0.26 (95% CI 0.12 to 0.52), respectively. In contrast, past history of stroke and availability of echocardiographic information, regardless of the findings, each increased warfarin use (P=0.03, OR 1.95 [95% CI 1.04 to 3.68], and P=0.0001, OR 3.52 [95% CI 2.16 to 5.72], respectively).. Old age, language difficulties, insufficient doctor alertness to warfarin benefit, and patient disability produced reluctance to treat. Warfarin use still lags behind requirements.

Topics: Age Factors; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Atrial Fibrillation; Chronic Disease; Communication Barriers; Comorbidity; Drug Prescriptions; Drug Utilization; Echocardiography; Female; Heart Diseases; Hospital Departments; Hospitalization; Humans; Israel; Lung Diseases, Obstructive; Male; Middle Aged; Physician-Patient Relations; Physicians; Practice Patterns, Physicians'; Recurrence; Refusal to Treat; Retrospective Studies; Risk Factors; Stroke; Thyrotoxicosis; Warfarin

To assess the aetiological contribution made to spontaneous epistaxis in adults over the age of 50 years by various groups of drugs, a controlled study was designed. Fifty-three consecutive epistaxis patients were compared with 50 controls. Significant differences were found between the groups in their consumption of warfarin, dipyridamole and non-steroidal anti-inflammatory drugs. Hypertension was equally common in the two groups, but tended to be less well controlled in the epistaxis patients compared to the controls. It is thought that the link between the use of nonsteroidal anti-inflammatory drugs and the occurrence of epistaxis may be due to alteration of platelet function.

Topics: Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Arthritis; Coronary Disease; Dipyridamole; Epistaxis; Female; Humans; Hypertension; Lung Diseases, Obstructive; Male; Middle Aged; Prospective Studies; Warfarin

Rifampin is known to lower plasma warfarin concentrations by increasing the rate of warfarin clearance. We have described a patient in whom an additional potentiating influence on warfarin effect was observed during treatment with rifampin and isoniazid. After cessation of rifampin and isoniazid, prothrombin time was maintained within the same range by a 50% reduction of warfarin doses, despite a twofold rise in the plasma warfarin concentration. This rise in warfarin concentrations can be explained by the known mechanism by which rifampin increases warfarin clearance. After cessation of rifampin, warfarin fractional clearance decreased from 15.2 to 4.2 ml/min; however, the unchanged prothrombin time in the face of the increased warfarin concentration can be explained only by the removal of a potentiating effect that had been present during the coadministration of rifampin and isoniazid. It is likely that rifampin is responsible for this additional potentiating interaction, probably not through a change in warfarin binding, but through a differential effect on warfarin stereoisomer metabolism or through an altered dynamic effect. The role of isoniazid in this interaction cannot be completely ruled out.

Topics: Adult; Drug Administration Schedule; Drug Synergism; Drug Therapy, Combination; Female; Humans; Isoniazid; Lung Diseases, Obstructive; Prothrombin Time; Rifampin; Stimulation, Chemical; Tuberculosis, Pulmonary; Warfarin

Topics: Aged; Aorta, Abdominal; Aortic Aneurysm; Cardiomegaly; Coronary Disease; Heparin; Humans; Lung Diseases, Obstructive; Male; Pulmonary Embolism; Warfarin

Two patients had breast necrosis after sodium warfarin (Coumadin) therapy. This well recognized, but rare, complication of anticoagulation therapy also occurs in other areas of the body. The cause is not known. We present these cases and discuss the literature.

Topics: Aged; Breast; Breast Diseases; Dose-Response Relationship, Drug; Female; Humans; Lung Diseases, Obstructive; Middle Aged; Necrosis; Prothrombin Time; Pulmonary Embolism; Warfarin

Topics: Administration, Oral; Aged; Electrocardiography; Humans; Lung Diseases, Obstructive; Male; Oxygen Inhalation Therapy; Physical Therapy Modalities; Positive-Pressure Respiration; Radiography; Tetracycline; Theophylline; Warfarin