Prevention of Bleeding in Older Patients Taking Warfarin
Authors: Rebecca J. Beyth, C. Seth Landefeld
Journal: Annals of Internal Medicine (2001)

Letters2 October 2001Prevention of Bleeding in Older Patients Taking WarfarinRebecca J. Beyth, MD, MS and C. Seth Landefeld, MDRebecca J. Beyth, MD, MSBaylor College of Medicine; Houston TX, 77030 (Beyth)University of California, San Francisco; San Francisco CA, 94118 (Landefeld)Search for more papers by this author and C. Seth Landefeld, MDBaylor College of Medicine; Houston TX, 77030 (Beyth)University of California, San Francisco; San Francisco CA, 94118 (Landefeld)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-7-200110020-00017 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate the comments of Dr. Spyropoulos and agree that there is compelling evidence of the benefits of specialized programs that coordinate management of anticoagulant therapy over “usual care” (1). In addition to the health benefits, the potential economic benefits of an organized process of care for anticoagulant therapy have been noted (2). Since we did not have a nurse- or pharmacist-managed AMS available at our institution, we cannot make any direct comparisons between our intervention and such a management service.Regarding Dr. Kajubi's comments, we did not routinely measure hematocrit levels in our study, and the portable monitors we used measured only the INR. As noted in our study and others (3), most anticoagulant-related bleeding is gastrointestinal. Furthermore, occult upper gastrointestinal lesions are often “unmasked” when patients receive anticoagulant therapy (4, 5). In contrast, specific causes of lower gastrointestinal bleeding during anticoagulant therapy are identified less often. Before routinely including fecal occult blood testing in the management of all patients treated with long-term anticoagulant therapy, its potential health and economic benefits should be formally studied.References1. Samsa GP, Matchar DB, Goldstein LB, Bonito AJ, Lux LJ, Witter DM, et al . Quality of anticoagulation management among patients with atrial fibrillation: results of a review of medical records from 2 communities. Arch Intern Med. 2000;160:967-73. [PMID: 10761962] CrossrefMedlineGoogle Scholar2. Lafata JE, Martin SA, Kaatz S, Ward RE. The cost-effectiveness of different management strategies for patients on chronic warfarin therapy. J Gen Intern Med. 2000;15:31-7. [PMID: 10632831] CrossrefMedlineGoogle Scholar3. White RH, McKittrick T, Takakuwa J, Callahan C, McDonell M, Fihn S. Management and prognosis of life-threatening bleeding during warfarin therapy. National Consortium of Anticoagulation Clinics. Arch Intern Med. 1996;156:1197-201. [PMID: 8639014] CrossrefMedlineGoogle Scholar4. Wilcox CM, Truss C. Gastrointestinal bleeding in patients receiving long-term anticoagulant therapy. Am J Med. 1988;84:683-90. [PMID: 3261126] CrossrefMedlineGoogle Scholar5. Tabibian N. Acute gastrointestinal bleeding in anticoagulated patients: a prospective evaluation. Am J Gastroenterol. 1989;84:10-2. [PMID: 2783528] MedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Baylor College of Medicine; Houston TX, 77030 (Beyth)University of California, San Francisco; San Francisco CA, 94118 (Landefeld) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 2 October 2001Volume 135, Issue 7Page: 549KeywordsAnticoagulant therapyHealth economicsHematocritHematologic testsHemorrhageInternational normalized ratioLesions ePublished: 2 October 2001 Issue Published: 2 October 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...