An Examination of the Association Between Therapeutic Anticoagulation Control and Glycemic Control for Patients with Diabetes on Oral Anticoagulation Therapy

Johnson, Samuel G.; Witt, Daniel M.; Delate, Thomas; Sadler, Melanie A.

doi:10.1007/s11239-005-1715-9

Cited by 7 publications

(7 citation statements)

References 13 publications

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“…However, there was no difference between diabetic patients and nondiabetic patients pertaining to anticoagulant control as measured by INR in our study. This is in concert with the findings in 911 anticoagulated diabetic patients, in whom no association between the level of glycemic control and therapeutic anticoagulation control was found [13]. Hence, changed pharmacodynamics or inadequate anticoagulant control is less likely.…”

Section: Discussionsupporting

confidence: 76%

Less Benefit from Warfarin in Diabetics after Myocardial Infarction?

Smith

Hurlen²,

Abdelnoor³

et al. 2008

Cardiology

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Objectives: To examine the impact of prognostic factors on the outcome of treatment with warfarin or aspirin after acute myocardial infarction. Methods: Patients from the Warfarin Aspirin Re-Infarction Study, assigned to treatment with warfarin (n = 1,216) or aspirin (n = 1,206) after myocardial infarction, were stratified according to important prognostic factors. Survival from the composite endpoint of death, myocardial infarction and thromboembolic stroke was estimated within each stratum by odds ratios (OR). The effect of therapy was then tested for heterogeneity across the two groups. Unadjusted analyses were complemented with regression analyses. Results: In diabetics the OR was 1.54 (95% CI 0.80–2.94) compared to 0.75 (95% CI 0.60–0.93) in nondiabetic patients. The latter difference was statistically significant when testing for heterogeneity, suggesting effect modification of warfarin by diabetes. After adjusting for confounders, diabetic patients who received warfarin had a 56% excess risk of an endpoint as compared with those receiving aspirin. By contrast, nondiabetic patients on warfarin had a 22% lower risk of an endpoint than those allocated to aspirin. Conclusions: The present data suggest less benefit from warfarin as compared to aspirin in diabetics. The mechanisms behind this remain in question.

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Section: Discussionsupporting

confidence: 76%

Less Benefit from Warfarin in Diabetics after Myocardial Infarction?

Smith

Hurlen²,

Abdelnoor³

et al. 2008

Cardiology

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“…[15][16][17][18][19][20][21][22][23][24][25][26][27][28] Our updated systematic search from January 2005 through February 2008 (as depicted in Figure 1) identified an additional 536 studies for full text review, of which 526 were excluded. Of the studies excluded, most were excluded because they were not conducted in the United States, or they were not a primary study.…”

Section: ■■ Resultsmentioning

confidence: 99%

“…Of these, 16 studies were excluded because patients were included for indications other than AF. 14,15,19,[22][23][24][25][27][28][29][30][32][33][34]36,37 Thus, 8 studies, including a total of 14 study groups, met all of the inclusion criteria and were included in the final analysis (Table 1). 17,18,20,21,26,31,35,38 The study groups enrolled a median of 317 patients (interquartile range, 150 to 482 patients; total = 22,237 warfarintreated patients), 31 who were followed for a median of 272.3 patient-years (range, 123.9 to 980.8 patient-years; total = 41,471.9 patient-years).…”

Section: ■■ Resultsmentioning

confidence: 99%

Meta-Analysis to Assess the Quality of Warfarin Control in Atrial Fibrillation Patients in the United States

Baker

Cios²,

Sander³

et al. 2009

JMCP

368

223

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BACKGROUND: Atrial fibrillation (AF) affects a significant proportion of the American population and increases ischemic stroke risk by 4-to 5-fold. Oral vitamin K antagonists, such as warfarin, can significantly reduce this stroke risk but can be difficult to dose and monitor. Previous research on the effects of setting (e.g., randomized controlled trials, anticoagulation management by specialty clinics, usual care by community physicians) on the proportion of time spent within therapeutic range for the international normalized ratio (INR) has not specifically examined anticoagulation in AF patients.OBJECTIVES: Use traditional meta-analytic and meta-regressive techniques to evaluate the effect of specialty clinic versus usual care by community physicians on anticoagulation control, measured as the proportion of time spent in therapeutic INR range, for AF patients that received warfarin anticoagulation in the United States.METHODS: Studies included in a previously published meta-analysis (van Walraven et al., 2006), which systematically searched reports between 1987 and 2005, were also screened for inclusion in our analysis. A subsequent systematic literature search of MEDLINE, EMBASE, and the Cochrane Central Register of Clinical Trials from January 2005 through February 2008 was conducted. Studies were included if they (a) contained at least 1 warfarin-treated group including more than 25 patients for whom INR control was monitored for at least 3 weeks; (b) included patients treated for AF in the United States; (c) used a patient-time approach (patient-year) to report outcomes; and (d) reported data on the proportion of time spent in traditional therapeutic INR ranges (i.e., a lower limit INR between 1.8 and 2.0 and an upper limit INR between 3.0 and 3.5. Studies with INR goals outside this range were excluded). The proportion of time spent within the therapeutic INR range for each study group was expressed as an incidence density using a person-time approach (in years). All studies were pooled using a random effects model and were weighted by the inverse of the variance of proportion of time spent in the therapeutic range. In order to determine how study setting influenced the proportion of time spent within a therapeutic INR range, both subgroup and meta-regression analyses were conducted.RESULTS: This analysis included 8 studies and a total of 14 unique warfarin-treated groups; 3 of the 8 studies and 4 of the warfarin groups were not included in the previous meta-analysis (van Walraven et al., 2006). Overall, patients spent a mean 55% (95% CI = 51%-58%) of their time in the therapeutic INR range. Meta-regression suggested that AF patients treated in a community usual care setting compared with an anticoagulation clinic spent 11% (95% CI = 2%-20%, n = 6 studies with 9 study groups) less time in range.CONCLUSIONS: In the United States, AF patients spend only about one-half the time within therapeutic INR. Anticoagulation clinic services are associated with somewhat better INR control compared with stan...

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“…Fourteen of the studies included in the study conducted by van Walraven et al 11 met the inclusion criteria. [16][17][18][19][20][21][22][23][24][25][26][27][28][29] As depicted in Figure 1, the updated systematic search identified 536 studies for full-text review, of which 526 were excluded. The most common reasons for exclusion were that the studies were not conducted within the United States and were not primary studies.…”

Section: Resultsmentioning

confidence: 99%

“…The most common reasons for exclusion were that the studies were not conducted within the United States and were not primary studies. Thus, an additional 10 studies 30-39 met the inclusion criteria, resulting in a total of 24 studies, including a total of 43 separate [16][17][18]20,21,23,24,[26][27][28][29][30]33,35,36,39 while 21 (50%) evaluated warfarin dosing in community practice. 16,19,21,22,25,26,28,29,32,34,[37][38][39] No randomized controlled trials were available for evaluation in this meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Evaluating the impact of study-level factors on warfarin control in U.S.-based primary studies: A meta-analysis

Cios

Baker

Sander

et al. 2009

American Journal of Health-System Pharmacy

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An Examination of the Association Between Therapeutic Anticoagulation Control and Glycemic Control for Patients with Diabetes on Oral Anticoagulation Therapy

Abstract: For patients with diabetes on warfarin anticoagulation therapy, there is no association between glycemic control and therapeutic anticoagulation control. However, anticoagulation therapy providers should manage these patients with the same diligence and care as patients without diabetes.

Cited by 7 publications

References 13 publications

Less Benefit from Warfarin in Diabetics after Myocardial Infarction?

Less Benefit from Warfarin in Diabetics after Myocardial Infarction?

Meta-Analysis to Assess the Quality of Warfarin Control in Atrial Fibrillation Patients in the United States

Evaluating the impact of study-level factors on warfarin control in U.S.-based primary studies: A meta-analysis

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