Over-anticoagulation by vitamin K antagonists and gender differences. (1st September 2022)

• Record Type: Journal Article
• Authors: Barcellona, D.; Schirru, P.; Mameli, A.; Cornacchini, S.; Fenu, L.; Marongiu, F.
• Is Part Of: International journal of cardiology. Volume 362(2022)
• Page Start: 147
• Page End: 151
• Publication Date: 2022-09-01
• Subjects: Warfarin -- Acenocoumarol -- Overdoses, male gender -- Female gender -- Bleeding; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.05.003
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Several studies have shown that in patients treated with vitamin K antagonists (VKAs) time spent in therapeutic range (TTR) is lower in females than in males. This retrospective study has evaluated a possible association among over-anticoagulation and gender, type and indications to VKAs, TTR and bleeding. Moreover, the decrease of the INR level, after VKAs withdrawal, was considered. Methods: From December 2020 to January 2004, 1230 patients with venous thromboembolism or atrial fibrillation were enrolled. Age, gender, type of VKAs, clinical indications, INR values and bleeding events were recorded. TTR was calculated considering the entire period of treatment. Results: A total of 1616 and 1759 over-anticoagulation episodes were found in males and females, respectively. The median INR value was 4.5 (4.0–19.04). Thirty-two percent of the patients did not have an overdose throughout the observation period. The median number of over-anticoagulation per year was significantly higher in females (0.39-year) than in males (0.28-year). After 24 h of VKAs withdrawal, INRs were similar in both genders. Logistic regression analysis showed that the episodes of over-anticoagulation per year were associated with females, atrial fibrillation, warfarin therapy, follow-up length longer than 4 years, and TTR <73%, but were not associated to bleeding episodes. Conclusion: The higher number of over-anticoagulation can explain the lower TTR in females. An excess of anticoagulation is not associated with bleeding events. The recovery of INR performs better when acenocoumarol is used, therefore, in patients who present several episodes of over-anticoagulation, acenocumarolo could replace warfarin. Highlights: Over-anticoagulation episodes are more frequent in females than in males and this finding can justify the lower TTR in females. In almost all the patients, over-anticoagulation is not associated with bleeding events so stopping VKAs is enough to reverse an excess of anticoagulation. Recovery of INR performs better with acenocoumarol that could be used in patients who present several over-anticoagulation episodes during their anticoagulant therapy. Recovery of INR values does not differ in males and females treated with both warfarin and acenocoumarol.