Show simple item record

dc.contributor.authorParadise, Helen T.
dc.contributor.authorBerlowitz, Dan R.
dc.contributor.authorOzonoff, Al
dc.contributor.authorMiller, Donald R.
dc.contributor.authorHylek, Elaine M.
dc.contributor.authorAsh, Arlene S.
dc.contributor.authorJasuja, Guneet K.
dc.contributor.authorZhao, Shibei
dc.contributor.authorReisman, Joel I.
dc.contributor.authorRose, Adam J.
dc.date2022-08-11T08:08:32.000
dc.date.accessioned2022-08-23T15:58:27Z
dc.date.available2022-08-23T15:58:27Z
dc.date.issued2014-06-01
dc.date.submitted2015-08-10
dc.identifier.citationJ Gen Intern Med. 2014 Jun;29(6):855-61. doi: 10.1007/s11606-014-2784-2. Epub 2014 Feb 19. <a href="http://dx.doi.org/10.1007/s11606-014-2784-2">Link to article on publisher's site</a>
dc.identifier.issn0884-8734 (Linking)
dc.identifier.doi10.1007/s11606-014-2784-2
dc.identifier.pmid24549520
dc.identifier.urihttp://hdl.handle.net/20.500.14038/30438
dc.description.abstractBACKGROUND: 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.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=24549520&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4026501/
dc.subjectAdult
dc.subjectAged
dc.subjectAnticoagulants
dc.subject*Atrial Fibrillation
dc.subjectBlood Coagulation
dc.subjectCohort Studies
dc.subjectComorbidity
dc.subjectDrug Monitoring
dc.subjectFemale
dc.subject*Hemorrhage
dc.subjectHumans
dc.subjectMale
dc.subject*Mental Disorders
dc.subjectMiddle Aged
dc.subjectProportional Hazards Models
dc.subjectPsychiatric Status Rating Scales
dc.subjectRetrospective Studies
dc.subjectRisk Adjustment
dc.subjectRisk Factors
dc.subjectThromboembolism
dc.subjectUnited States
dc.subject*Warfarin
dc.subjectCardiology
dc.subjectCardiovascular Diseases
dc.subjectHealth Services Research
dc.subjectMental and Social Health
dc.subjectPsychiatry and Psychology
dc.titleOutcomes of anticoagulation therapy in patients with mental health conditions
dc.typeJournal Article
dc.source.journaltitleJournal of general internal medicine
dc.source.volume29
dc.source.issue6
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/faculty_pubs/710
dc.identifier.contextkey7435825
html.description.abstract<p>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.</p> <p>OBJECTIVE: To examine the relationship between the severity of MHCs and outcomes of anticoagulation therapy.</p> <p>DESIGN: Retrospective cohort analysis.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p>
dc.identifier.submissionpathfaculty_pubs/710
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.source.pages855-61


This item appears in the following Collection(s)

Show simple item record