scholarly journals Vitamin K Concentration and Cognitive Status in Elderly Patients on Anticoagulant Therapy: A Pilot Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ludovico Alisi ◽  
Clodomiro Cafolla ◽  
Alessandra Gentili ◽  
Sara Tartaglione ◽  
Roberta Curini ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Anticoagulant Therapy ◽  
Vitamin K ◽  
Cognitive Functions ◽  
Oral Anticoagulant Therapy ◽  
Vitamin K Antagonists ◽  
Positive Association ◽  
Cognitive Status ◽  
Vitamin K1 ◽  
The Relationship

Objectives. Recent studies have suggested that vitamin K may exert significant effects on the central nervous system. The present study investigates the relationship between vitamin K plasmatic levels and cognitive functions in elderly patients on oral anticoagulant therapy (OAT). Design. At the Thrombosis Centre of Haematology, “Sapienza” University of Rome, 85 patients on OAT, aged between 75 and 92, were randomly enrolled in the study. Patients were on OAT with vitamin K antagonists (VKAs). Vitamin K1 concentrations were determined using standardized High-Performance Liquid Chromatography (HPLC). Cognitive functions were assessed using the Milan Overall Dementia Assessment (MODA). Results. MODA scores are positively correlated to vitamin K1 concentration. Patients with vitamin K1 below 0.100 μg/L and between 0.100 and 0.400 μg/L showed a mean MODA score of 79 ± 5 and 82 ± 3, respectively. Patients with vitamin K1 above 0.400 μg/L had a significantly greater MODA score (89 ± 1). After binning the data into bicentiles, MODA scores are shown to be linearly dependent on vitamin K1 concentrations (p<0.001). Even long-term OAT (>10 years) does not affect MODA scores. Education seems to exert a greater role on the cognitive status in comparison with aging. Conclusions. The study shows a positive association between vitamin K1 concentration and cognitive status in elderly patients (≥75 years) on OAT. The relationship between vitamin K1 concentration and MODA scores is described by a linear model. Cognitive status is not influenced by the duration of OAT but by the years of education.

Suspension of Vitamin K Antagonists Is Not Required for Cataract Surgery: A Prospective Study in a Cohort of 135 Consecutive Patients on Long-Term Anticoagulant Therapy.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 882-882
Author(s):  
Berardino Pollio ◽  
Giuseppe A. Demarie ◽  
Patrizia Ocello ◽  
Grazia Delios ◽  
Marco Tucciarone ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Anticoagulant Therapy ◽  
Vitamin K ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Vitamin K Antagonists ◽  
Management Service ◽  
Corneal Incision ◽  
Standardized Protocol

Abstract The perioperative management of oral anticoagulant therapy (OAT) often arouses controversy between surgeons and internists. In geriatric patients, cataract surgery for those who are taking vitamin K antagonists is a common clinical procedure. Phacoemulsification requires a 3 mm incision involving a tissue devoid of blood vessels. This study reports the experience of an Italian Anticoagulation Management Service (AMS) with 135 anticoagulated patients on long-term anticoagulant therapy who underwent phacoemulsification performed by the same ophthalmologist team from January 2001 to December 2005. The patients received either topical (30%) or peribulbar (70%) anaesthesia. Data were collected by physicians with specialized software, but the dosage of oral anticoagulant was manual. Two oral vitamin K antagonisists are available in Italy: acenocumarol and warfarin. We prepared all patients in accordance with the following standardized protocol : the scheduled dose was always omitted the day before surgery an INR measurement was provided 3–5 days before the invasive procedure; if the patient’s INR was below 3, we simply omitted the scheduled dose of the day before cataract surgery if the patient’s INR was above 3, we withheld two or more scheduled doses to allow the INR to fall to 2.5 or less 1 hour before cataract surgery, INR was measured if the patient’s INR was below 2.5, phacoemulsification was performed Results: This standardized procedural protocol allowed the surgeon to carry out phacoemulsification with INR always below 2.5. We observed only one peribulbar bleeding (0.7%) during peribulbar anaesthesia before the corneal incision was made. No thromboembolic complications were registered during three months of follow up. We compared our results with the data of an earlier cohort of 7014 conventional patients who underwent this eye surgery in the same ophthalmologic institute. We did not observe statistical differences between the two groups with regard to hemorragic complications. Conclusions: The risk of thromboembolism when antithrombotic therapy is interrupted is a well-grounded concern, particularly for patients with mechanical heart valves. Low molecular weight heparin bridging is a valid but more complicated alternative. Our study demonstrates the feasibility and safety of this simple standardized protocol which avoids OAT interruption. Therefore, we conclude that in patients receiving OAT, it is not necessary for the anticoagulant effect to wear off before cataract surgery is performed.

scholarly journals Incidence of complications of antithrombotic treatment in patients with atrial fibrillation

2013 ◽  
Vol 66 (11-12) ◽  
pp. 470-475
Author(s):  
Sladjana Novakovic-Anucin ◽  
Sanja Gnip ◽  
Visnja Canak ◽  
Pavica Radovic ◽  
Jelena Kovacev ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Anticoagulant Therapy ◽  
Vitamin K ◽  
Oral Anticoagulant Therapy ◽  
Vitamin K Antagonists ◽  
Combined Treatment ◽  
Thromboembolic Complications ◽  
Antithrombotic Treatment ◽  
Hemorrhagic Complications

Introduction. Atrial fibrillation increases the risk of ischemic stroke five fold, while the application of long-term anticoagulant therapy is associated with the occurrence of hemorrhagic complications. The aim of our study was to evaluate the incidence of thrombotic and hemorrhagic complications in patients with atrial fibrillation during antithrombotic treatment. Material and Methods. The study included 504 patients that were administered the primary (n=345) or secondary thromboprophylaxis after ischemic stroke (n=159), by applying vitamin K antagonists, or the combination of vitamin K antagonists and low-dose aspirin. The patients were followed for five months in the period of 24 years from 1988 to 2012, the total number of patient?s years being 1884, at the Clinical Center of Vojvodina. Thromboembolic and hemorrhagic complications were registered during regular check-up examinations. Results and Discussion. Our results indicate the low incidence of thromboembolic complications (0.01 patient per a year), with a lower incidence in the vitamin K antagonists group than in the group with the combination of vitamin K antagonists and aspirin (0.008 patient per a year versus 0.01 patient per a year). The incidence of hemorrhagic complications was higher in the group with the combined treatment compared to the group treated with vitamin K antagonists (0.1 patient per a year versus 0.06 patient per a year). The frequency of major bleeding was as low as 0.01 patient per a year and more frequent in the group with combined treatment (0.03 patient per a year). Conclusion. The overall incidence of complications in the study group was 0.08 patient per a year. The combined antithrombotic treatment increases the risk of hemorrhagic complications and affects the severity of bleeding. Oral anticoagulant therapy is more efficient in the prevention of ischemic stroke and thromboembolic complications in patients with atrial fibrillation.

scholarly journals Anticoagulation therapy in the elderly with non-valvular atrial fibrillation: a double-edged sword

2017 ◽  
Vol 3 (2) ◽  
Author(s):  
Francesco Vetta ◽  
Gabriella Locorotondo ◽  
Giampaolo Vetta
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Anticoagulant Therapy ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Treatment Strategies ◽  
The Elderly ◽  
Hemorrhagic Events

Prevalence of non-valvular atrial fibrillation is increasing over time. Particularly in elderly population, treatment strategies to reduce the rate of stroke are challenging and still represent an unsolved cultural question. Indeed, the risk of thromboembolism increases in the elderly in parallel with the risk of bleeding. The frequent coexistence of several morbidities, frailty syndrome, polypharmacy, chronic kidney disease and dementia strengthens the perception that risk-benefit ratio of anticoagulant therapy could be unfavorable, and explains why such treatment is underused in the elderly. Recently, the introduction of non-vitamin K oral anticoagulants (NOACs) has allowed us to overcome the large number of limitations imposed by the use of vitamin K antagonists. In this manuscript, the benefits of individual NOACs in comparison with warfarin in elderly patients are reviewed. Targeted studies on complex elderly patients are needed to test usefulness of a geriatric comprehensive assessment, besides the scores addressing risk of thromboembolic and hemorrhagic events. In the meantime, it is mandatory that use of anticoagulant therapy in most elderly people, currently excluded from randomized controlled trials, is prudent and responsible.

scholarly journals Safety and differences between direct oral anticoagulants and vitamin K antagonists in the risk of post-traumatic intrathoracic bleeding after rib fractures in elderly patients

2021 ◽  
Vol 17 (4) ◽  
Author(s):  
Gianni Turcato ◽  
Arian Zaboli ◽  
Andrea Tenci ◽  
Giorgio Ricci ◽  
Massimo Zannoni ◽  
...  
Keyword(s):  
Anticoagulant Therapy ◽  
Vitamin K ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Traumatic Bleeding ◽  
Post Traumatic

Closed chest traumas are frequent consequences of falls in the elderly. The presence of concomitant oral anticoagulant therapy can increase the risk of post-traumatic bleeding even in cases of trauma with non-severe dynamics. There is limited information about the differences between vitamin K antagonists and direct oral anticoagulants in the risk of post-traumatic bleeding. To assess differences in the risk of developing intra-thoracic hemorrhages after chest trauma with at least one rib fracture caused by an accidental fall in patients over 75 years of age taking oral anticoagulant therapy. This study involved data from four emergency departments over two years. All patients on oral anticoagulant therapy and over 75 years of age who reported a closed thoracic trauma with at least one rib fracture were retrospectively evaluated. Patients were divided into two study groups according their anticoagulant therapy. Of the 342 patients included in the study, 38.9% (133/342) were treated with direct oral anticoagulants and 61.1% (209/342) were treated with vitamin K antagonist. A total of 7% (24/342) of patients presented intrathoracic bleeding, while 5% (17/342) required surgery or died as a result for the trauma. Posttraumatic intrathoracic bleeding occurred in 4.5% (6/133) of patients receiving direct oral anticoagulants and 8.6% (18/209) of patients receiving vitamin K antagonist. Logistic regression analysis, revealed no difference in the risk of intrathoracic haemorrhages between the two studied groups. Direct oral anticoagulants therapy presents a risk of post-traumatic intrathoracic haemorrhage comparable to that of vitamin K antagonist therapy.

Relation of Personality Traits in Patients with Oral Anticoagulant Therapy to Attitudes towards Treatment with Vitamin-K Antagonists.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4183-4183
Author(s):  
Job Harenberg ◽  
Lutz Frölich ◽  
Marie-Theres Felten ◽  
Christel Weiss
Keyword(s):  
Personality Traits ◽  
Anticoagulant Therapy ◽  
Vitamin K ◽  
Oral Anticoagulant Therapy ◽  
Vitamin K Antagonists ◽  
Bleeding Complications ◽  
Bleeding Events ◽  
Advisory Committees ◽  
Chi Square ◽  
Chi Square Test

Abstract Abstract 4183 Stable anticoagulation as determined by the international standardized ratio (INR) remains difficult despite increasing knowledge on pharmacogenetics of vitamin K antagonists (VKA) and improved therapeutic approaches. We hypothesised that personality traits of patients may influence attitudes towards treatment VKA. Thirty patients treated with VKA for more than one year completed a widely used personality inventory (Freiburger Persönlichkeitsinventar, FPI-R) and a questionnaire referring to adherence, safety and anxiety problems during anticoagulant therapy after written informed consent. Indications for anticoagulation were venous thromboembolism (n=22) and atrial fibrillation (n=8). Correlations between FPI-R factors and items of the anticoagulant therapy questionnaire were analysed by means of the chi-square test. Patients understanding the concept of VKA therapy and being open for modifications of the dose of VKA, they are more emotional and less excitable (p=0.008 and 0.009), respectively. Patients who felt burdened at initiation of VKA therapy were less achievement-oriented (p=0.02). Those who forget sometimes the intake of the VKA are more self-inhibited (p=0.004) and more socially oriented (p=0.007). Patients following a diet during anticoagulant therapy, are more concerned about general health (p=0.009) and are more socially orientated (p=0.05). Those who like to eat vitamin-K containing vegetables are more excitable (p=0.01). Importantly, patients being afraid of thrombotic events are more aggressive (p=0.01) and have more physical complaints (p=0.02). Those being afraid of bleeding complications, are more aggressive (p=0.046), more demanded (p=0.05) and more intraverted (p=0.004). Personality traits appear to influence the therapy with VKA manifold. Fear of thrombotic or bleeding events during anticoagulant therapy can be identified by specific personality traits. Disclosures: Harenberg: Bristol-Myers Squibb: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi Aventis: Consultancy, Honoraria; Roche Diagnostics: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Bayer Health Care: Consultancy, Honoraria.

Stroke severity in patients with preceding direct oral anticoagulant therapy as compared to vitamin K antagonists

2019 ◽  
Vol 266 (9) ◽  
pp. 2263-2272 ◽  
Author(s):  
Elias Auer ◽  
Sebastién Frey ◽  
Johannes Kaesmacher ◽  
Arsany Hakim ◽  
David J. Seiffge ◽  
...  
Keyword(s):  
Anticoagulant Therapy ◽  
Vitamin K ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Vitamin K Antagonists ◽  
Stroke Severity ◽  
Direct Oral Anticoagulant
Sign in / Sign up

Export Citation Format

Share Document