warfarin and Respiratory-Tract-Infections

Topics: Biopsy; Drug Eruptions; Drug Interactions; Eosinophils; Erythromycin; Female; Fluocortolone; Hematoma; Humans; Leukocytes, Mononuclear; Middle Aged; Mitral Valve Insufficiency; Neutrophils; Prothrombin Time; Respiratory Tract Infections; Skin Diseases, Vesiculobullous; Trimethoprim, Sulfamethoxazole Drug Combination; Warfarin

To estimate the association between untreated, community acquired, respiratory tract infections and bleeding in oral anticoagulant users.. Self-controlled case series.. General practices in England contributing data to the Clinical Practice Research Datalink GOLD.. 1208 adult users of warfarin or direct oral anticoagulants with a general practice or hospital admission record of a bleeding event between January 2010 and December 2019, and a general practice record of a consultation for a community acquired respiratory tract infection for which immediate antibiotics were not prescribed (that is, untreated).. Relative incidence of major bleeding and clinically relevant non-major bleeding in the 0-14 days after an untreated respiratory tract infection, compared to unexposed time periods.. Of 1208 study participants, 58% (n=701) were male, median age at time of first bleed was 79 years (interquartile range 72-85), with a median observation period of 2.4 years (interquartile range 1.3-3.8). 292 major bleeds occurred during unexposed time periods and 41 in the 0-14 days after consultation for a respiratory tract infection. 1003 clinically relevant non-major bleeds occurred during unexposed time periods and 81 in the 0-14 days after consultation for a respiratory tract infection. After adjustment for age, season, and calendar year, the relative incidence of major bleeding (incidence rate ratio 2.68, 95% confidence interval 1.83 to 3.93) and clinically relevant non-major bleeding (2.32, 1.82 to 2.94) increased in the 0-14 days after an untreated respiratory tract infection. Findings were robust to several sensitivity analyses and did not differ by sex or type of oral anticoagulant.. This study observed a greater than twofold increase in the risk of bleeding during the 0-14 days after an untreated respiratory tract infection. These findings have potential implications for how patients and clinicians manage oral anticoagulant use during an acute intercurrent illness and warrant further investigation into the potential risks and how they might be mitigated.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Community-Acquired Infections; England; Female; Hemorrhage; Humans; Incidence; Male; Respiratory Tract Infections; Risk Factors; Warfarin

 Many patients on warfarin therapy often present with supratherapeutic international normalized ratio (INR) levels, resulting from the influence of several patient-specific factors, which have been associated with adverse outcomes..  This article aims to identify risk factors for over-anticoagulation (INR levels ≥4) in a cohort of patients taking warfarin..  A cohort of warfarin users aged 18 to 85 years from January 2005 to April 2013 was identified in The Health Improvement Network U.K. primary care database (.  Among the factors examined, the strongest predictors of over-anticoagulation were warfarin indication (in particular, valvular atrial fibrillation and valve replacement), renal failure (with the risk increasing steeply with decreasing estimated glomerular filtration rate), cancer, anaemia, respiratory infections treated with antibiotics, chronic obstructive pulmonary disease treated with β2-agonists, polypharmacy (≥10 medications), low socio-economic status and residency in rural areas. Similar results were obtained when supratherapeutic levels were defined as INR ≥5 or, alternatively, as INR > 3..  Predictors of supratherapeutic INR levels found in this study might help physicians identify patients where closer INR monitoring is warranted.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia; Anticoagulants; Blood Coagulation; Case-Control Studies; Databases, Factual; Female; Glomerular Filtration Rate; Humans; International Normalized Ratio; Male; Medical Overuse; Middle Aged; Neoplasms; Odds Ratio; Poverty; Primary Health Care; Pulmonary Disease, Chronic Obstructive; Regression Analysis; Renal Insufficiency; Respiratory Tract Infections; Rural Population; United Kingdom; Warfarin; Young Adult

We report cerebral embolism in 2 patients with Duchenne muscular dystrophy (DMD) after respiratory tract infection. A 31-year-old man (Case 1) was admitted to the hospital because of an upper respiratory tract infection, then suddenly developed left-sided hemiparesis. Transthoracic echocardiography revealed an intracardiac thrombus in the left ventricle, and, under assumption of cardioembolic stroke, oral anticoagulation was initiated. Case 2 was a 36-year-old man who developed dysphasia after increasing sputum. Based on brain CT scan findings, we confirmed a diagnosis of cerebral infarction. There was no recurrence in either case. Both cases developed cerebral infarction due to embolism after mild upper respiratory tract infections. DMD patients have various risk factors for thrombus and embolus, while physicians should also be aware of possible cerebral infarction and other coagulation disorders irrespective of respiratory and cardiac therapy.

Topics: Adult; Anticoagulants; Aspirin; Brain; Diffusion Magnetic Resonance Imaging; Echocardiography; Heart Diseases; Heart Ventricles; Heparin; Humans; Intracranial Embolism; Magnetic Resonance Angiography; Male; Muscular Dystrophy, Duchenne; Respiratory Tract Infections; Risk; Thrombosis; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

A 34-year-old woman who had been using oral contraceptives for 10 years developed hypertensive crisis with papilloedema after an upper respiratory infection. Laboratory data showed hyperreninemic hyperaldosteronism and elevated levels of fibrinogen, fibrin, and fibrinogen degradation products. Echocardiography demonstrated two masses (18 mm) in the left ventricle. On the fourth hospital day, cerebral infarction, renal infarction, and upper mesenteric artery occlusion suddenly occurred despite the blood pressure being well-controlled using anti-hypertensive drugs. Echocardiography revealed the disappearance of the left ventricular masses, which suggested left ventricular thrombi. Cessation of the contraceptives and administration of heparin, warfarin, and anti-platelets drugs improved her general condition.

Topics: Adult; Antihypertensive Agents; Blood Pressure; Contraceptives, Oral; Echocardiography; Female; Fibrin Fibrinogen Degradation Products; Fibrinogen; Heart Ventricles; Heparin; Humans; Hypertension; Respiratory Tract Infections; Thrombosis; Treatment Outcome; Warfarin

The place of thromboprophylaxis in arthroplasty surgery remains controversial, with a challenging requirement to balance prevention of potentially fatal venous thrombo-embolism with minimising wound-related complications leading to deep infection. We compared the incidence of fatal pulmonary embolism in patients undergoing elective primary total hip arthroplasty (THA) between those receiving aspirin, warfarin and low molecular weight heparin (LMWH) for the chemical component of a multi-modal thromboprophylaxis regime.. A prospective audit database was used to identify patients who had died within 42 and 90 days of surgery respectively between April 2000 and December 2012. A case note review was performed to ascertain the causes of death.. During this period 7983 THAs were performed. The rate of mortality was 0.43% and 0.58% at 42 and 90 days respectively. The groups comprised 1571 patients (19.7%) on warfarin, 1838 (23.0%) on LMWH and 4574 (57.3%) on aspirin. The 90-day mortality for these three groups was 0.38%, 1.09% and 0.43% respectively. The higher mortality rate for LMWH was significant (p < 0.05). There were six fatal pulmonary emboli (PEs) (0.08%). A total of three occurred within 42 days, all in the LMWH group. A total of three occurred between 42 and 90 days; one on warfarin, two on LMWH. The leading causes of death in all three groups were lower respiratory tract infections and myocardial infarction.. We confirmed that fatal PE following elective THA with a multi-modal prophylaxis regime is rare. We further found that LMWH conferred no benefit over aspirin in this context, and is associated with a higher all-cause rate of mortality.. This study proposes that aspirin may be an appropriate thromboprophylaxis agent when used as part of a multi-modal regimen, suggesting current guidelines should be reviewed. Cite this article: Bone Joint J 2016;98-B:585-8.

Topics: Aged; Anticoagulants; Arthroplasty, Replacement, Hip; Aspirin; Chemoprevention; Clinical Audit; Elective Surgical Procedures; Heparin, Low-Molecular-Weight; Humans; Myocardial Infarction; Platelet Aggregation Inhibitors; Postoperative Complications; Prospective Studies; Pulmonary Embolism; Respiratory Tract Infections; United Kingdom; Warfarin

Topics: Abnormalities, Drug-Induced; Anticoagulants; Female; Humans; Imaging, Three-Dimensional; Infant, Newborn; Male; Nasal Bone; Pregnancy; Respiratory Distress Syndrome, Newborn; Respiratory Tract Infections; Tracheotomy; Ultrasonography, Prenatal; Warfarin