Quality of oral anticoagulation treatment in real-life practice and factors associated with optimal therapeutic response in elderly patients

Introduction. Oral anticoagulation therapy (OAT) is recommended in several cardiovascular disorders and is increasingly used in elderly patients. Obtaining a stable value of International Normalized Ratio (INR) within the target levels may however represent a difficult goal, in this population. Indeed, there is suggestion that out of range INR values are frequently seen in clinical practice. This fact may be associated with serious adverse events such as bleeding and thromboembolic disorders, which may be often fatal in elderly people. Aim of the present study was to evaluate the factors associated with an increased risk of out of range INR levels in this subgroup of patients. Methods. Consecutive patients admitted to the Emergency Department of two Italian Institutions were analyzed within two hours of their admission. Only patients 70 years or older were eligible for the study. Results. 242 patients were enrolled, 151 of whom (62.4%) with abnormal values. When comparing the characteristics of those within or outside the normal range, it appeared that the former had a higher educational level (27% vs 5%) and more frequently a duration of treatment longer than 5 years (62% vs 27%): OR=7.36; 95% C.I. 3.02-17.95; p < 0.0001, and OR=4.29; 95% C.I. 2.46-7.47; p < 0.0001, respectively. Discussion. The majority of patients in this sample of elderly patients seem unable to maintain optimal INR values. The risk seems higher in patients with a low level of education and with less than 5 year OAT

Quality of oral anticoagulation treatment in real-life practice and factors associated with optimal therapeutic response in elderly patients

Introduction. Oral anticoagulation therapy (OAT) is recommended in several cardiovascular disorders and is increasingly used in elderly patients. Obtaining a stable value of International Normalized Ratio (INR) within the target levels may however represent a difficult goal, in this population. Indeed, there is suggestion that out of range INR values are frequently seen in clinical practice. This fact may be associated with serious adverse events such as bleeding and thromboembolic disorders, which may be often fatal in elderly people. Aim of the present study was to evaluate the factors associated with an increased risk of out of range INR levels in this subgroup of patients. Methods. Consecutive patients admitted to the Emergency Department of two Italian Institutions were analyzed within two hours of their admission. Only patients 70 years or older were eligible for the study. Results. 242 patients were enrolled, 151 of whom (62.4%) with abnormal values. When comparing the characteristics of those within or outside the normal range, it appeared that the former had a higher educational level (27% vs 5%) and more frequently a duration of treatment longer than 5 years (62% vs 27%): OR=7.36; 95% C.I. 3.02-17.95; p < 0.0001, and OR=4.29; 95% C.I. 2.46-7.47; p < 0.0001, respectively. Discussion. The majority of patients in this sample of elderly patients seem unable to maintain optimal INR values. The risk seems higher in patients with a low level of education and with less than 5 year OAT

Comorbility and recurrent hospitalization in Internal Medicine

Background: Most studies on demographic data from industrialised countries clearly demonstrate a trend towards aging of the population, associated with an increase chronic disorders, often coexisting in the same subject. Consequently, the burden of patients with the above mentioned characteristics is becoming overwhelming for all hospital wards, and especially for those of Internal Medicine. Objectives: Aim of the study is to evaluate the characteristics of the patients admitted to a ward of acute Internal Medicine, the frequency of recurrent admissions in subjects of 65 years and over, and the reasons for readmission. Methods: This is a retrospective analysis of admissions to the General Medicine Department of S. Spirito Hospital (Rome) during the year 2005. The main demographic and clinical characteristics were recorded in each patient aging 65 years or more, hospitalized during the first 3 months of the year, and correlated with the readmission rate during the subsequent nine months. Results: During the first three months of 2005, 259 patients were hospitalized: 195 (75.3%) aged 65 years or more. Forty-seven patients aging 65 years or more (24.1%) were readmitted at least once during the subsequent 9 months. In comparison to older patients who did not require further admissions, those with re-admissions had more frequently three or more concomitant diseases: 40 out of 47 vs. 67 out of 148; Odds ratio = 6.9, 95% confidence intervals: 2.9-16.4, p < 0.0001 (univariate analysis). Conclusions: These data suggest greater relationship between hospital and territory, in order to ensure a continuum in the care of older patients

Effects of opiates on blood rheology

To evaluate the possible effect of opiates on blood rheology, the plasma fibrinogen, prothrombin time and leukocyte aggregation were measured in 75 heroin addicts categorized by the time of abstention from heroin and the administration of naltrexone (25 active heroin abusers, 25 abstaining for 1 week, 11 abstaining for at least 5 months and 14 abstaining for 1 month and taking naltrexone during this period). No difference was detected in prothrombin time, but the leukocyte aggregation and fibrinogen were significantly different among the four groups (p = 0.028 and p = 0.0001, respectively). In particular, fibrinogen was 318 +/- 10.9 mg/dL in heroin abusers, significantly higher than that of the remaining three groups; the percentage of aggregated leukocytes was 5.01 +/- 0.77 in heroin users, significantly higher than that of subjects abstaining for at least 5 months. The fibrinogen levels declined sharply with abstention and an additive effect was noted with the administration of naltrexone, but leukocyte aggregation changed more slowly, and the effect of naltrexone (if any) was weaker. These data indicate an adverse effect of opiates on blood rheology and suggest that further studies should be performed to evaluate whether naltrexone may be useful in the prevention of major ischemic syndromes in patients with hyperfibrinogenemia and, perhaps, in those with high levels of leukocyte aggregation

Effects of opiates on blood rheology

To evaluate the possible effect of opiates on blood rheology, the plasma fibrinogen, prothrombin time and leukocyte aggregation were measured in 75 heroin addicts categorized by the time of abstention from heroin and the administration of naltrexone (25 active heroin abusers, 25 abstaining for 1 week, 11 abstaining for at least 5 months and 14 abstaining for 1 month and taking naltrexone during this period). No difference was detected in prothrombin time, but the leukocyte aggregation and fibrinogen were significantly different among the four groups (p = 0.028 and p = 0.0001, respectively). In particular, fibrinogen was 318 +/- 10.9 mg/dL in heroin abusers, significantly higher than that of the remaining three groups; the percentage of aggregated leukocytes was 5.01 +/- 0.77 in heroin users, significantly higher than that of subjects abstaining for at least 5 months. The fibrinogen levels declined sharply with abstention and an additive effect was noted with the administration of naltrexone, but leukocyte aggregation changed more slowly, and the effect of naltrexone (if any) was weaker. These data indicate an adverse effect of opiates on blood rheology and suggest that further studies should be performed to evaluate whether naltrexone may be useful in the prevention of major ischemic syndromes in patients with hyperfibrinogenemia and, perhaps, in those with high levels of leukocyte aggregation