Reduction in emergency department visits by patients attending an anticoagulation clinic

Excerpt

Introduction Recent studies suggest that warfarin therapy may be linked to cardiac valve calcification. We aimed to establish whether calcification (C) of valves or other tissue occurs with warfarin and to examine if such C was influenced by treatment duration, age, or gender. Methods We performed a retrospective review of 50 long-term warfarin recipients and 50 untreated controls, matched for age, gender, and comorbidity. For inclusion, patients required a recent echocardiogram (within 18 months) and at least one CT-scan and X-ray. We determined a calcification score (CS) for each patient; one point per site was given for C reported in the aortic, mitral, or tricuspid valve, aorta, coronary and carotid arteries, peripheral vessels, kidney, lung, or other locations. Results The groups were matched for hypertension, diabetes, and coronary disease (P = NS); however, males were younger (64 ± 3 vs. 73 ± 2 years; P = 0.03). Most patients received warfarin for valve replacement (42%) or atrial fibrillation (36%); mean treatment duration, 99 ± 3 months. Analysis revealed five main results; (1) Warfarin-associated CS was increased in cardiac valves (P = 0.01 vs. control) and at each assessed site except the coronary arteries. (2) Total CS was higher with warfarin (2.7 ± 0.3) than controls (1.8 ± 0.2; P = 0.02). (3) CS correlated with warfarin treatment duration (P = 0.03). (4) When all patients were assessed, CS correlated with age for both groups, but was always higher with warfarin (P = 0.02 vs. control). (5) However, this effect was due to warfarin-induced C in males. Total CS was higher for warfarin-treated males (2.4 ± 0.4) versus controls (1.2 ± 0.2; P < 0.01), irrespective of age (P < 0.01). In contrast, we found no differences between warfarin-treated and control females. Conclusions Long-term warfarin therapy was associated with tissue calcification not only in valves, but also at other sites. For our entire warfarin-treated group, calcification correlated with treatment duration and age; however, the most pronounced increases occurred in males. …