Browsing by Subject "Warfarin"

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  • Kinnunen, P. T. T.; Murtola, T. J.; Talala, K.; Taari, K.; Tammela, T. L. J.; Auvinen, A. (2019)
    PurposeAnticoagulants may reduce mortality of cancer patients, though the evidence remains controversial. We studied the association between different anticoagulants and cancer death.MethodsAll anticoagulant use during 1995-2015 was analyzed among 75,336 men in the Finnish Randomized Study of Screening for Prostate Cancer. Men with prevalent cancer were excluded. Multivariable Cox regression was performed to compare risk of death from any cancer and disease-specific death from 9 specific cancer types between (1) anticoagulant users overall and (2) warfarin users compared to anticoagulant non-users and (3) warfarin or (4) low-molecular-weight heparins (LMWH) compared to users of other anticoagulants. Medication use was analyzed as time-dependent variable to minimize immortal time bias. 1-, 2- and 3-year lag-time analyses were performed.ResultsDuring a median follow-up of 17.2years, a total of 27,233 men died of whom 8033 with cancer as the primary cause of death. In total, 32,628 men (43%) used anticoagulants. Any anticoagulant use was associated with an increased risk of cancer death (HR=2.50, 95% CI 2.37-2.64) compared to non-users. Risk was similar independent of the amount, duration, or intensity of use. The risk increase was observed both among warfarin and LMWH users, although not as strong in warfarin users. Additionally, cancer-specific risks of death were similar to overall cancer mortality in all anticoagulant categories.ConclusionOur study does not support reduced cancer mortality among anticoagulant users. Future studies on drug use and cancer mortality should be adjusted for anticoagulants as they are associated with significantly higher risk of cancer death.
  • Nissfolk, Anna (Helsingfors universitet, 2017)
    Aortaklaffstenos är den vanligaste indikationen för implantation av biologisk aortaklaff. Enligt vårdrekommendationer har patienterna antikoagulativ behandling med warfarin i tre månader efter operationen. Målet med studien är att kartlägga blödningar hos patienter med biologisk aortaklaffprotes, samt undersöka riskfaktorer för blödning i denna patientgrupp. Undersökningen gjordes på material som retrospektivt samlats in ur patientjournaler från universitetssjukhus i Finland och är en del i CARE-AVR-projektet. I materialet ingick 721 patienter och det förekom totalt 98 blödningsincidenter under uppföljningstiden, av dessa var 56 stora blödningar. I studien framkommer att behandlad hypertension innan aortaklaffimplantationen tredubblar risken för stor blödning. Permanent warfarinbehandling vid 3 månader efter operationen ökar risken för blödning. Kön, ålder vid operationen, diabetesbehandling och hjärtsvikt inverkar inte på blödningsrisken. En modifierad HAS-BLED klassifikation lämpar sig inte som verktyg vid bedömning av blödningsrisken hos patienter med biologisk AVR.
  • Mustonen, Pirjo; Lehto, Mika; Putaala, Jukka (2018)
  • Tiili, Paula; Lehto, Mika; Meretoja, Atte; Nieminen, Tuomo; Pakarinen, Sami; Tatlisumak, Turgut; Putaala, Jukka (2016)
  • Rissanen, Antti; Herse, Fredrik; Rossi, Jari; Säävuori, Niina; Roine, Risto O.; Pakarinen, Sami (2021)
    Lähtökohdat : Suoria antikoagulantteja ja varfariinia käytetään ei-läppäperäiseen eteisvärinään liittyvän aivohalvauksen estossa, mutta toistaiseksi eri antikoagulaatiolääkityksellä olevista suomalaisista potilaista on rajallisesti tosielämän tietoon perustuvia tutkimuksia. Menetelmät : utkimme rekisteritiedolla antikoagulaatiohoitoa saavien eteisvärinäpotilaiden palvelukäyttöä, lääkitystä sekä potilasprofiilia. Tarkastelimme lääkesegmenteittäin sosiaali- ja terveyspalvelujen käyttöä ja kustannuksia sekä aivotapahtumista ja ruoansulatuskanavan vuodoista johtuvia erikoissairaanhoidon ja ¬perusterveydenhuollon käyntejä ja hoitopäiviä potilailla, jotka olivat käyttäneet vähintään vuoden ¬samaa antikoagulanttia. Tulokset : Varfariinia ja apiksabaania määrätään keskimäärin vanhemmille ja korkeamman riskin potilaille kuin muita antikoagulantteja. Eteisvärinäpotilaiden yhteenlasketut sote-palveluiden kustannukset olivat vuonna 2018 noin 2 miljardia euroa. Haittatapahtumista aivoinfarktit ja aivotapahtumien jälkitilat aiheuttivat eteisvärinä¬potilaille eniten palvelukäyttöä. Päätelmät : Eteisvärinäpotilaiden hoidosta kertyy yhteiskunnalle suuria kustannuksia. Suoria antikoagulantteja ja varfariinia käyttävien potilaiden välillä on eroja potilasprofiilissa sekä palvelukäytössä ja sen kustannuksissa.
  • Tiili, Paula; Putaala, Jukka; Mehtala, Juha; Khanfir, Houssem; Niiranen, Jussi; Korhonen, Pasi; Raatikainen, Pekka; Lehto, Mika (2019)
    Background: Intracranial hemorrhage (ICH) is a devastating complication of oral anticoagulation. The aim of this study was to describe the spectrum of ICH and to evaluate the association of warfarin control with the risk of ICH in a nationwide cohort of unselected atrial fibrillation (AF) patients. Methods and Results: The FinWAF is a retrospective registry-linkage study. Data were collected from several nationwide Finnish health-care registers and laboratory databases. The primary outcome was any ICH (traumatic or non-traumatic). The quality of warfarin therapy was assessed continuously by calculating the time in therapeutic range in a 60-day window (TTR60). Adjusted Cox proportional hazard models were used. A total of 53,953 patients were included (53% men; mean age, 73 years; mean follow-up, 2.94 years; mean TTR, 63%). In 129,684 patient-years, 1,196 patients had ICH (non-traumatic, 53.5%; traumatic, 43.6%; traumatic subdural, 38.6%); crude annual rate, 0.92%; 95% CI: 0.87-0.98). A lower TTR60 was significantly associated with higher risk of ICH (TTR60 80%; adjusted hazard ratio, 2.16; 95% CI: 1.83-2.54). Other variables independently associated with ICH included age >65 years, previous stroke, male sex, low hemoglobin, thrombocytopenia, elevated alanine aminotransferase, and previous bleeding other than ICH. Conclusions: Poor control of warfarin treatment was associated with elevated risk of ICH. Approximately half of the ICH were traumatic, mainly subdural.
  • Kinnunen, Pete T T; Murtola, Teemu J; Talala, Kirsi; Taari, Kimmo; Tammela, Teuvo L J; Auvinen, Anssi (BioMed Central, 2017)
    Abstract Background Venous thromboembolic events (VTE) are common in cancer patients and associated with higher mortality. In vivo thrombosis and anticoagulation might be involved in tumor growth and progression. We studied the association of warfarin and other anticoagulant use as antithrombotic medication and prostate cancer (PCa) death in men with the disease. Methods The study included 6,537 men diagnosed with PCa during 1995-2009. Information on anticoagulant use was obtained from a national reimbursement registry. Cox regression with adjustment for age, PCa risk group, primary therapy and use of other medication was performed to compare risk of PCa death between warfarin users with 1) men using other types of anticoagulants and 2) non-users of anticoagulants. Medication use was analyzed as a time-dependent variable to minimize immortal time bias. Results In total, 728 men died from PCa during a median follow-up of 9 years. Compared to anticoagulant non-users, post-diagnostic use of warfarin was associated with an increased risk of PCa death (overall HR 1.47, 95% CI 1.13-1.93). However, this was limited to low-dose, low-intensity use. Otherwise, the risk was similar to anticoagulant non-users. Additionally, we found no risk difference between warfarin and other types of anticoagulants. Pre-diagnostic use of warfarin was not associated with the risk of PCa death. Conclusions We found no reduction in risk of PCa death associated with warfarin use. Conversely, the risk was increased in short-term use, which is probably explained by a higher risk of thrombotic events prompting warfarin use in patients with terminal PCa.
  • Kinnunen, Pete T. T.; Murtola, Teemu J.; Talala, Kirsi; Taari, Kimmo; Tammela, Teuvo L. J.; Auvinen, Anssi (2017)
    Background: Venous thromboembolic events (VTE) are common in cancer patients and associated with higher mortality. In vivo thrombosis and anticoagulation might be involved in tumor growth and progression. We studied the association of warfarin and other anticoagulant use as antithrombotic medication and prostate cancer (PCa) death in men with the disease. Methods: The study included 6,537 men diagnosed with PCa during 1995-2009. Information on anticoagulant use was obtained from a national reimbursement registry. Cox regression with adjustment for age, PCa risk group, primary therapy and use of other medication was performed to compare risk of PCa death between warfarin users with 1) men using other types of anticoagulants and 2) non-users of anticoagulants. Medication use was analyzed as a time-dependent variable to minimize immortal time bias. Results: In total, 728 men died from PCa during a median follow-up of 9 years. Compared to anticoagulant nonusers, post-diagnostic use of warfarin was associated with an increased risk of PCa death (overall HR 1.47, 95% CI 1. 13-1.93). However, this was limited to low-dose, low-intensity use. Otherwise, the risk was similar to anticoagulant non-users. Additionally, we found no risk difference between warfarin and other types of anticoagulants. Pre-diagnostic use of warfarin was not associated with the risk of PCa death. Conclusions: We found no reduction in risk of PCa death associated with warfarin use. Conversely, the risk was increased in short-term use, which is probably explained by a higher risk of thrombotic events prompting warfarin use in patients with terminal PCa.
  • Udd, Marianne; Saarnio, Juha (2019)
    Vuotopotilaalle aloitetaan protonipumpun estäjälääkitys, ja gastroskopia pyritään tekemään 24 tunnissa sairaalaan tulosta. Maltillinen verensiirtostrategia, jossa hemoglobiinin tavoitepitoisuus on 70 g/l, parantaa potilaan ennustetta verrattuna liberaalimpaan strategiaan Endoskooppisessa hoidossa adrenaliiniruiskutukseen on liitettävä toinen menetelmä: liimaus, vuodon termaalinen koagulaatio tai klipsaus. Jos vuoto uusii, gastroskopia ja vuodon tyrehdytys endoskooppisesti toistetaan. Jos vuoto yhä jatkuu, potilas ohjataan angioembolisaatioon tai päivystysleikkaukseen.
  • Helin, Tuukka; Metso, Tuula; Holvitie, Jukka; Valtonen, Kirsi; Lassila, Riitta; Mäki, Tiina; Joutsi-Korhonen, Lotta (Suomen lääkäriliitto, 2013)
  • Helin, Tuukka; Metso, Tuula; Holvitie, Jukka; Valtonen, Kirsi; Lassila, Riitta; Mäki, Tiina; Joutsi-Korhonen, Lotta (2013)
  • Salmela, Birgitta; Niiranen, Jussi; Viitasalo, Matti (2018)
    Amiodaroni on erittäin tehokas, mutta potentiaalisesti toksinen rytmihäiriölääke. Jokaisen potilaita hoitavan lääkärin tulee osata epäillä sen haittavaikutuksia. Niiden hoito ja amiodaronilääkityksen jatkaminen arvioidaan erikoissairaanhoidossa.
  • Lund, Juha; Pakarinen, Sami; Inkovaara, Jaakko (2018)