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March 1, 1995Postgraduate Medical JournalOpen Access

Effect of age upon the induction and maintenance of anticoagulation with warfarin

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Why the study?

Does older age increase the risk of over-anticoagulation during induction and maintenance of warfarin therapy?

Population

739 patients receiving maintenance warfarin therapy and 495 patients undergoing induction at a routine…

Comparison

Warfarin therapy (induction and maintenance) vs Younger patients (age-based comparison)

Design

Cohort

Authors

JGJohn GladmanNottingham University Hospitals NHS TrustGDGayle P. DolanDepartment of Health and Social Care

Discussion

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Implication

Older age linked to higher warfarin over-anticoagulation risk; leaves open whether age-adjusted induction protocols improve safety.

Key Points

  • To examine the influence of age on anticoagulation control during both the induction and maintenance phases of warfarin therapy in routine clinical practice.
  • Retrospective review of routine anticoagulation clinic records from University Hospital, Nottingham.
  • Assessed INR response and dosing patterns during the induction phase (N=495) and the maintenance phase (N=739).
  • During induction, marked over-anticoagulation (INR > 6.0) occurred in 11% (54/495) of patients and was significantly more likely in older individuals (p < 0.05), with 58% of patients aged ≥75 reaching an INR > 4.0 despite receiving unreduced loading doses.
  • During maintenance, INR rose with advancing age (p < 0.001) despite significantly lower maintenance doses (p < 0.001), and INR > 6.0 occurred in 3% (24/739) of patients, remaining more common in older cohorts (p < 0.05).

Structured PICO

Does older age increase the risk of over-anticoagulation during induction and maintenance of warfarin therapy?

P
Population
739 patients receiving maintenance warfarin therapy and 495 patients undergoing induction at a routine anticoagulation clinic
I
Intervention
Warfarin therapy (induction and maintenance)
C
Comparator
Younger patients (age-based comparison)
O
Outcome
Over-anticoagulation (INR > 6.0 or INR > 4.0) during induction and maintenance phasessafety

Older patients are at higher risk of over-anticoagulation with warfarin, suggesting that standard loading doses may be inappropriate and require age-adjusted protocols.

Cite This Study

Gladman et al. (1995) studied this question.

synapsesocial.com/papers/6a869309a063193d080cfaa3https://doi.org/10.1136/pgmj.71.833.153
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The Association of Age with Dosage Requirement for Warfarin1991 · 71 citations
  2. 2LONG-TERM ORAL ANTICOAGULANT THERAPY IN ELDERLY PATIENTS1988 · 55 citations
  3. 3Predicting warfarin maintenance dosage based on initial response1979 · 17 citations
  4. 4Efficacy and Toxicity of Heparin in Relation to Age and Sex1968 · 220 citations
  5. 5Survey of use of anticoagulation in patients with atrial fibrillation.1993 · 92 citations