Challenges of anticoagulation for atrial fibrillation in patients with severe sepsis.
نویسندگان
چکیده
BACKGROUND Although numerous studies have shown that anticoagulation of nonvalvular atrial fibrillation (AF) significantly decreases the risk of stroke, anticoagulating critically ill patients in the intensive care unit (ICU) poses many challenges and the benefits have not been determined. OBJECTIVE To assess the safety and efficacy of anticoagulation in AF patients with sepsis. Ascertaining the incidence of complications associated with anticoagulation therapy, such as bleeding, can optimize patient care. METHODS This was a retrospective observational study to assess the incidence of stroke and anticoagulation-related complications (eg, bleeding, heparin-induced thrombocytopenia) in AF patients with severe sepsis. This study was undertaken in a surgical/medical ICU of a teaching, community-based hospital. A total of 115 patients with AF who were admitted with a diagnosis of sepsis were included in the study. RESULTS Among 115 patients (mean age 81 ± 9.5 years and CHADS2 [congestive heart failure, hypertension, age >75 years, diabetes mellitus, stroke] score 3.17 ± 1.20), 80 (69.6%) did not receive anticoagulation treatment during their hospitalization and none of these patients developed a stroke. Anticoagulation-related complications occurred more often in the group who received anticoagulation (8.6% [3/35] vs 0%, P = .008). In the anticoagulated group, a majority of the patients were within therapeutic range less than 50% of the time during their ICU stay. There was no statistically significant difference in survival rates during their hospitalization (66.2% [53/80] for the non-anticoagulated group vs 74.3% [26/35] in the anticoagulated group, P = .392). CONCLUSION Administration of anticoagulation for elderly patients with a CHADS2 score at 2 or more in the setting of sepsis can be associated with an increased risk of anticoagulation-related complications (eg, bleeding, heparin-induced thrombocytopenia). Managing and targeting a therapeutic goal with warfarin therapy in critically ill patients with sepsis is challenging. Further studies are necessary to provide appropriate recommendations in this setting.
منابع مشابه
فرآیند درمانی فیبریلاسیون دهلیزی در بیمارستان های ایران
Background: Lack of attention to standardized guidelines has caused tragic outcome in patients with atrial fibrillation and ultimately increase of financial burden imposed on the community structure of the economic system. Therefore, the present study was aimed to assess the exposure of patients with atrial fibrillation. Methods: A total of 506 patients with atrial fibrillation were...
متن کاملبررسی عوامل موثر بر لخته داخل دهلیز چپ در بیمارانی که تحت عمل جراحی دریچه میترال قرار گرفته اند
Background and Aim: Rheumatic heart disease (RHD) is a serious health problem in developing countries. Mitral stenosis is one of the most prevalent forms of RHD and one of the causes of systemic thromboembolism in Iran. The present study was conducted to evaluate the relationship between left atrial clot and mitral valve disease. Materials and Methods: This case-control study was done on all p...
متن کاملInvestigation of the relationship between pharmacological knowledge of anticoagulants with medication adherence in the elderly patients with atrial fibrillation
Introduction and Aim: In the elderly, the rate of adherence to the medication regimen and the rate of remembering how to correctly prescribe medication is low due to old age and memory loss, which leads to poor therapeutic results. The aim of this study was to determine the relationship between anticoagulants knowledge and adherence to treatment in elderly cardiac patients with atrial fibrillat...
متن کاملA Semi-Automated Algorithm for Segmentation of the Left Atrial Appendage Landing Zone: Application in Left Atrial Appendage Occlusion Procedures
Background: Mechanical occlusion of the Left atrial appendage (LAA) using a purpose-built device has emerged as an effective prophylactic treatment in patients with atrial fibrillation at risk of stroke and a contraindication for anticoagulation. A crucial step in procedural planning is the choice of the device size. This is currently based on the manual analysis of the “Device Landing Zone” fr...
متن کاملNew-onset atrial fibrillation in sepsis is associated with increased morbidity and mortality
BACKGROUND The development of new-onset atrial fibrillation in sepsis has been associated with adverse outcomes. METHODS A systematic literature search was conducted to retrieve articles that investigated the association of new-onset atrial fibrillation in patients diagnosed with sepsis. The primary outcome of interest was the pooled risk ratio (RR) of in-hospital mortality in patients with n...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- The Annals of pharmacotherapy
دوره 47 10 شماره
صفحات -
تاریخ انتشار 2013