BACKGROUND: Patients with mental health conditions (MHCs) experience poor anticoagulation control when using warfarin, but we have limited knowledge of the association between specific mental illness and warfarin treatment outcomes. OBJECTIVE: To examine the relationship between the severity of MHCs and outcomes of anticoagulation therapy. DESIGN: Retrospective cohort analysis. PARTICIPANTS: We studied 103,897 patients on warfarin for 6 or more months cared for by the Veterans Health Administration during fiscal years 2007-2008. We identified 28,216 patients with MHCs using ICD-9 codes: anxiety disorders, bipolar disorder, depression, post-traumatic stress disorder, schizophrenia, and other psychotic disorders. MAIN MEASURES: Outcomes included anticoagulation control, as measured by percent time in the therapeutic range (TTR), as well as major hemorrhage. Predictors included different categories of MHC, Global Assessment of Functioning (GAF) scores, and psychiatric hospitalizations. KEY RESULTS: Patients with bipolar disorder, depression, and other psychotic disorders experienced TTR decreases of 2.63 %, 2.26 %, and 2.92 %, respectively (p < 0.001), after controlling for covariates. Patients with psychotic disorders other than schizophrenia experienced increased hemorrhage after controlling for covariates [hazard ratio (HR) 1.24, p = 0.03]. Having any MHC was associated with a slightly increased hazard for hemorrhage (HR 1.19, p < 0.001) after controlling for covariates. CONCLUSION: Patients with specific MHCs (bipolar disorder, depression, and other psychotic disorders) experienced slightly worse anticoagulation control. Patients with any MHC had a slightly increased hazard for major hemorrhage, but the magnitude of this difference is unlikely to be clinically significant. Overall, our results suggest that appropriately selected patients with MHCs can safely receive therapy with warfarin.
BACKGROUND:Patients with mental health conditions (MHCs) experience poor anticoagulation control when using warfarin, but we have limited knowledge of the association between specific mental illness and warfarin treatment outcomes. OBJECTIVE: To examine the relationship between the severity of MHCs and outcomes of anticoagulation therapy. DESIGN: Retrospective cohort analysis. PARTICIPANTS: We studied 103,897 patients on warfarin for 6 or more months cared for by the Veterans Health Administration during fiscal years 2007-2008. We identified 28,216 patients with MHCs using ICD-9 codes: anxiety disorders, bipolar disorder, depression, post-traumatic stress disorder, schizophrenia, and other psychotic disorders. MAIN MEASURES: Outcomes included anticoagulation control, as measured by percent time in the therapeutic range (TTR), as well as major hemorrhage. Predictors included different categories of MHC, Global Assessment of Functioning (GAF) scores, and psychiatric hospitalizations. KEY RESULTS:Patients with bipolar disorder, depression, and other psychotic disorders experienced TTR decreases of 2.63 %, 2.26 %, and 2.92 %, respectively (p < 0.001), after controlling for covariates. Patients with psychotic disorders other than schizophrenia experienced increased hemorrhage after controlling for covariates [hazard ratio (HR) 1.24, p = 0.03]. Having any MHC was associated with a slightly increased hazard for hemorrhage (HR 1.19, p < 0.001) after controlling for covariates. CONCLUSION:Patients with specific MHCs (bipolar disorder, depression, and other psychotic disorders) experienced slightly worse anticoagulation control. Patients with any MHC had a slightly increased hazard for major hemorrhage, but the magnitude of this difference is unlikely to be clinically significant. Overall, our results suggest that appropriately selected patients with MHCs can safely receive therapy with warfarin.
Authors: Susan M Frayne; Donald R Miller; Erica J Sharkansky; Valerie W Jackson; Fei Wang; Jewell H Halanych; Dan R Berlowitz; Boris Kader; Craig S Rosen; Terence M Keane Journal: Am J Med Qual Date: 2009-10-23 Impact factor: 1.852
Authors: Stuart J Connolly; Janice Pogue; John Eikelboom; Gregory Flaker; Patrick Commerford; Maria Grazia Franzosi; Jeffrey S Healey; Salim Yusuf Journal: Circulation Date: 2008-10-27 Impact factor: 29.690
Authors: Jane S Saczynski; Saket R Sanghai; Catarina I Kiefe; Darleen Lessard; Francesca Marino; Molly E Waring; David Parish; Robert Helm; Felix Sogade; Robert Goldberg; Jerry Gurwitz; Weijia Wang; Tanya Mailhot; Benita Bamgbade; Bruce Barton; David D McManus Journal: J Am Geriatr Soc Date: 2019-10-01 Impact factor: 5.562
Authors: Jussi Jaakkola; Konsta Teppo; Fausto Biancari; Olli Halminen; Jukka Putaala; Pirjo Mustonen; Jari Haukka; Miika Linna; Janne Kinnunen; Paula Tiili; Aapo L Aro; Juha Hartikainen; K E Juhani Airaksinen; Mika Lehto Journal: Eur Heart J Qual Care Clin Outcomes Date: 2022-05-05
Authors: Brittany Gisi; Andrew D Althouse; Abigail S Mathier; Alexandra Pusateri; Bruce L Rollman; Anna LaRosa; Jared W Magnani Journal: Int J Cardiol Date: 2019-12-05 Impact factor: 4.164
Authors: Kueiyu Joshua Lin; Daniel E Singer; Robert J Glynn; Suzanne Blackley; Li Zhou; Jun Liu; Gina Dube; Lynn B Oertel; Sebastian Schneeweiss Journal: J Am Heart Assoc Date: 2017-10-05 Impact factor: 5.501