Prevention of Bleeding in Older Patients Taking Warfarin

Rebecca J. Beyth; C. Seth Landefeld

doi:10.7326/0003-4819-135-7-200110020-00017

Letters |2 October 2001

Prevention of Bleeding in Older Patients Taking Warfarin

Rebecca J. Beyth, MD, MS; C. Seth Landefeld, MD

Article, Author, and Disclosure Information

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.

FULL TEXT

PDF

Not Available

2001 American College of Physicians

Letters |2 October 2001

Prevention of Bleeding in Older Patients Taking Warfarin

Content

Information For

Services

Awards and Cover

Other Resources

Follow Annals On

Letters |2 October 2001

Prevention of Bleeding in Older Patients Taking Warfarin

Content

Information For

Services

Awards and Cover

Other Resources

Follow Annals On

You need a subscription to this content to use this feature.