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Excessive Anticoagulation Associated with Increased Mortality and Morbidity

Henry I. Bussey, Pharm.D.
August 2004

Review: Koos S, Kucher N, Nguyen PL, Fanikos J, Marks PW, Goldhaber SZ. The effect or excessive anticoagulation on mortality and morbidity in hospitalized patients with anticoagulant-related major hemorrhage. Archives of Internal Medicine 2004; 164:1557-1560.

Koo and colleagues recently evaluated the outcomes of 101 patients admitted with a major bleeding episode to Brigham and Women's Hospital in Boston. Fifty patients had excessive anticoagulation while anticoagulation was "non-excessive" in the remaining 51. Excessive anticoagulation was associated with 4.17 fold increase in mortality, 6.16 fold increase in intracranial hemorrhage, and a 3.79 fold likelihood of active cancer. The authors conclude that these data support the need to carefully maintain the INR within the target range and they recommend anticoagulation clinics, patient self testing, use of computer or nomogram directed dosing, and implementation of methods to avoid incorrect dosing of anticoagulants.

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