Abnormal mental capacity in elderly anticoagulated patients was associated with more time outside the therapeutic range than matched controls (20.9% vs 13.7%; OR 1.68; 95% CI 1.53-1.84; P<0.0001).
Case-Control (n=311)
Does reduced mental ability increase the time spent outside the intended therapeutic range in elderly patients receiving oral anticoagulant treatment?
Unsuspected reduction in mental ability in elderly patients on oral anticoagulation is associated with poorer INR control, highlighting the need for cognitive assessment to mitigate risks of thrombotic or bleeding complications.
Odds Ratio: 1.68 (95% CI 1.53–1.84)
Absolute Event Rate: 20.9% vs 13.7%
p-value: p=< 0.0001
Mental capacity was assessed in 311 apparently self-sufficient patients (> or = 60 years of age, 170 men) under stabilised oral anticoagulant treatment (OAT) by administering the Hodkinson's Abbreviated Mental Test (AMT). The international normalized ratios (INR) recorded during the 3 months before and the 3 after the data of test administration were examined by the INR-Day software program. The percentage of time spent within, below or above the intended therapeutic range was calculated in patients who scored abnormally at AMT, and compared with matched controls with normal AMT results. Forty patients 12.9%; 28 women (19.8%) and 12 men (7.1%), P < 0.0011 had abnormal AMT results; the rate seemed to increase with age. Most of these patients (35, 75%) had only elementary education. Patients with abnormal AMT results spent more time outside the intended therapeutic ranges than 40 matched controls (20.9% of the observed time vs 13.7%, P < 0.0001; odds ratio 1.68, CI 1.53-1.84). Unsuspected reduction of mental ability or attention levels was found in a number of elderly patients receiving OAT; these patients presented longer periods of either under- or over-anticoagulation and were, therefore, exposed to a higher risk of thrombotic or bleeding complications. Anticoagulation clinics would be advised to assess mental abilities in elderly patients before starting OAT.
Palareti et al. (Wed,) conducted a case-control in Oral anticoagulant treatment (n=311). Abnormal mental capacity (abnormal AMT score) vs. Normal mental capacity (matched controls) was evaluated on Percentage of time spent outside the intended therapeutic range (OR 1.68, 95% CI 1.53-1.84, p=< 0.0001). Abnormal mental capacity in elderly anticoagulated patients was associated with more time outside the therapeutic range than matched controls (20.9% vs 13.7%; OR 1.68; 95% CI 1.53-1.84; P<0.0001).
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