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Anticoagulation Education and Reduced Bleeding in the Elderly

Henry I. Bussey, Pharm.D.
October 2004

Review: Kagansky N, Knobler H, Rimon E, Ozer Z, Levy S. Safety of Anticoagulation Therapy in Well-informed Older Patients. Arch Intern Med. 2004 Oct 11;164(18):2044-50.

A recent study from Israel evaluated factors that correlated with major bleeding episodes in patients 80 years of age and older on anticoagulation therapy. 323 patients who were followed for a mean of 29 months had relatively few major bleeding events (22 events, 2.88 events per 100 patient-years). Three factors (low level of education about anticoagulation, INRs > 3, and those taking more than 7 medications) each was associated with an increased risk of major bleeding. However, insufficient patient education demonstrated the strongest relationship by far. Those who rated their educational experience as insufficient had an 8.8 fold greater risk (odds ratio) of having a major bleed. For INRs > 3 and more than 7 medications, the odds ratios were 1.08 and 6.1, respectively.

This report appears to be the first that has demonstrated such a strong relationship between patient education (or lack thereof) and major bleeding risk.

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