SynthesisCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2007
Frequency of adverse events in patients with poor anticoagulation: a meta-analysis.
Synthesis in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 41 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
41 citing papers in PubMed.
- Differences in the quality of oral anticoagulation therapy with vitamin K antagonists in German GP practices - results of the cluster-randomized PICANT trial (Primary Care Management for Optimized Antithrombotic Treatment).BMC health services research · 2019Trial
- Primary care management for patients receiving long-term antithrombotic treatment: A cluster-randomized controlled trial.PloS one · 2019Trial
- Oral anticoagulation with vitamin K inhibitors and determinants of successful self-management in primary care.BMC cardiovascular disorders · 2016Trial
- Sex differences in treatment quality of self-managed oral anticoagulant therapy: 6,900 patient-years of follow-up.PloS one · 2014Trial
- Comparison of initial warfarin response in obese patients versus non-obese patients.Journal of thrombosis and thrombolysis · 2013Trial
- Trial
- Burden and Determinants of Drug-Drug Interactions at Hospital Discharge: Warfarin as a Model for High-Risk Medication Safety.Clinics and practice · 2025Article
- Biomaterials-Enabled Antithrombotics: Recent Advances and Emerging Strategies.Molecular pharmaceutics · 2022Review
- Adherence to rivaroxaban for the treatment of venous thromboembolism-Results from the FIRST registry.Research and practice in thrombosis and haemostasis · 2021Article
- Article
- Implications of an inpatient warfarin dosing nomogram on safety outcomes post-discharge.Journal of thrombosis and thrombolysis · 2017Article
- Vitamin K antagonist use: evidence of the difficulty of achieving and maintaining target INR range and subsequent consequences.Thrombosis journal · 2016Review
- Natural history of bleeding and characteristics of early bleeders among warfarin initiators - a cohort study in Finland.Clinical epidemiology · 2016Article
- Risk Factors for Bleeding in Hospitalized at Risk Patients With an INR of 5 or More Treated With Vitamin K Antagonists.Medicine · 2015Article
- Oral anticoagulants and risk of nephropathy.Drug safety · 2015Review
- Effective and Safe Management of Oral Anticoagulation Therapy in Patients Who Use the Internet-Accessed Telecontrol Tool SintromacWeb.Interactive journal of medical research · 2015Article
- Resuming anticoagulation after brain hemorrhage while on warfarin treatment: INR at the time of bleeding should be taken into consideration-authors' reply.Internal and emergency medicine · 2015Article
- Center-Related Determinants of VKA Anticoagulation Quality: A Prospective, Multicenter Evaluation.PloS one · 2015Article
- Quality of vitamin K antagonist control and outcomes in atrial fibrillation patients: a meta-analysis and meta-regression.Thrombosis journal · 2014Article
- Practical Issues to Prevent Stroke Associated with Non-valvular Atrial Fibrillation.Journal of stroke · 2013Review
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPatients taking anticoagulants orally over the long term have international normalized ratios (INRs) outside the individual therapeutic range more than one-third of the time. Improved anticoagulation control will reduce hemorrhagic and thromboembolic event rates. To gauge the potential effect of improved anticoagulation control, we undertook to determine the proportion of anticoagulant-associated events that occur when INRs are outside the therapeutic range.
methodsWe conducted a meta-analysis of all studies that assigned hemorrhagic and thromboembolic events in patients taking anticoagulants to discrete INR ranges. We identified studies using the MEDLINE (1966-2006) and EMBASE (1980-2006) databases. We included studies reported in English if the majority of patients taking oral anticoagulants had an INR range with a lower limit between 1.8 and 2 and an upper limit between 3 and 3.5, and their INR at the time of the hemorrhagic or thromboembolic event was recorded.
resultsThe final analysis included results from 45 studies (23 that reported both hemorrhages and thromboemboli; 14 that reported hemorrhages only; and 8, thromboemboli only) involving a median of 208 patients (limits of interquartile range [25th-75th percentile] 131-523 subjects; total n = 71 065). Of these studies, 64% were conducted at community practices; the remainder, at anticoagulation clinics. About 69% of the studies were classed as having moderate or high quality. Overall, 44% (95% confidence interval [CI] 39%-49%) of hemorrhages occurred when INRs were above the therapeutic range, and 48% (95% CI 41%-55%) of thromboemboli took place when below it. The mean proportion of events that occurred while the patient's INR was outside the therapeutic range was greater for studies with a short mean follow-up (< 1 yr). Between-study heterogeneity was significant (p < 0.001).
interpretationImproved anticoagulation control could decrease the likelihood of almost half of all anticoagulant-associated adverse events.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.