This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wehinger, C. Articles by Finsterer, J. Search for Related Content PubMed PubMed Citation Articles by Wehinger, C. Articles by Finsterer, J. Related Collections Anticoagulants Arrhythmias, clinical electrophysiology, drugs Coumarins Primary and Secondary Stroke Prevention

(Stroke. 2001;32:2246.)
© 2001 American Heart Association, Inc.

Original Contributions

Evaluation of Risk Factors for Stroke/Embolism and of Complications Due to Anticoagulant Therapy in Atrial Fibrillation

Cornelius Wehinger, MD; Claudia Stöllberger, MD; Thomas Länger, Dipl Ing; Barbara Schneider, PhD Josef Finsterer, MD

From the Second Medical Department, KA Rudolfstiftung, Vienna (C.W., C.S); Austrian Research Centers Seibersdorf, Seibersdorf (T.L.); Institute for Medical Statistics and Documentation, University of Vienna (B.S.); and Second Neurological Department, Hospital Rosenhügel, Vienna (J.F.), Austria.

Reprint request to Dr Claudia Stöllberger, Steingasse 31/18, A-1030 Vienna, Austria. E-mail claudia.stoellberger{at}chello.at

Background and Purpose—— We sought to assess in outpatients with atrial fibrillation and oral anticoagulation (1) whether the complication rate is influenced by the presence of the risk factors age >65 years, arterial hypertension, diabetes, or previous stroke; (2) whether the complication rate is influenced by the number of additional drugs taken by patients; and (3) whether problems and interventions differ between patients with or without complications.

Methods—— Clinical characteristics, drugs, problems, interventions, and complications were registered during 2 years.

Results—— Three hundred sixty patients (mean age, 68 years; 43% female) were observed for 383 patient-years. Patients aged >65 years had more serious, life-threatening, or fatal complications (11% versus 5.3%/100 patient-years; P=0.0428) than younger patients. Patients with diabetes had more life-threatening and fatal complications (2.8% versus 0.6%/100 patient-years; P=0.0354) than patients without. The complication rate did not differ regarding the presence of previous stroke or hypertension. Patients who took 3 drugs had fewer complications than patients who took more (4.3% versus 24.4%/100 patient-years; P=0.0041). Patients with complications complained more of chest (48% versus 28%/100 patient-years; P=0.0113) and abdominal pain (30% versus 13%/100 patient-years; P=0.0057), more frequently failed to keep appointments (134% versus 107%/100 patient-years; P=0.0321), had a higher tracking rate (134% versus 105%/100 patient-years; P=0.0272), and took more additional drugs (4.6 versus 3.5 drugs per day; P=0.0063) than patients with no complications.

Conclusions—— Patients with increased age or diabetes mellitus or those who take >3 drugs per day have an increased complication rate and thus need especially careful monitoring of oral anticoagulation, including adequate pain control.

Key Words: aged • anticoagulants • complications • diabetes mellitus

This article has been cited by other articles:

				A. S. Kanderian, A. M. Gillinov, G. B. Pettersson, E. Blackstone, and A. L. Klein Success of Surgical Left Atrial Appendage Closure: Assessment by Transesophageal Echocardiography J. Am. Coll. Cardiol., September 9, 2008; 52(11): 924 - 929. [Abstract] [Full Text] [PDF]

				M. Hughes, G.Y.H. Lip, and on behalf of the Guideline Development Group for t Risk factors for anticoagulation-related bleeding complications in patients with atrial fibrillation: a systematic review QJM, October 1, 2007; 100(10): 599 - 607. [Abstract] [Full Text] [PDF]

				C. Stollberger, J. Finsterer, and B. Schneider Arguments Against Left Atrial Appendage Occlusion for Stroke Prevention Stroke, September 1, 2007; 38(9): e77 - e77. [Full Text] [PDF]

				P. Kakar, D. Lane, and G. Y. H. Lip Bleeding risk stratification models in deciding on anticoagulation in patients with atrial fibrillation: a useful complement to stroke risk stratification schema. Chest, November 1, 2006; 130(5): 1296 - 1299. [Full Text] [PDF]

				T. I. Shireman, J. D. Mahnken, P. A. Howard, T. F. Kresowik, Q. Hou, and E. F. Ellerbeck Development of a contemporary bleeding risk model for elderly warfarin recipients. Chest, November 1, 2006; 130(5): 1390 - 1396. [Abstract] [Full Text] [PDF]

				C. Stollberger, J. Finsterer, and B. Schneider Safety of Oral Anticoagulation in Elderly Atrial Fibrillation Patients to Prevent Strokes Stroke, August 1, 2006; 37(8): 1960 - 1961. [Full Text] [PDF]

				C. L. O'Brien and B. F. Gage Costs and Effectiveness of Ximelagatran for Stroke Prophylaxis in Chronic Atrial Fibrillation JAMA, February 9, 2005; 293(6): 699 - 706. [Abstract] [Full Text] [PDF]

				C. Stollberger, B. Schneider, and J. Finsterer Elimination of the Left Atrial Appendage To Prevent Stroke or Embolism?: Anatomic, Physiologic, and Pathophysiologic Considerations Chest, December 1, 2003; 124(6): 2356 - 2362. [Abstract] [Full Text] [PDF]

				J. H. Shuhaiber, M. Massad, and A. Geha Study design in valve surgery and outcome J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1660 - 1661. [Full Text] [PDF]

				I. Iyigun, C. Stollberger, C. Wehinger, and J. Finsterer Evaluation of Risk Factors for Stroke/Embolism and of Complications Due to Anticoagulant Therapy in Atrial Fibrillation * Response Stroke, September 1, 2002; 33(9): 2150 - 2152. [Full Text] [PDF]