The American Journal of Medicine
Volume 120, Issue 6 , Pages 539-544 , June 2007

The Safety of Warfarin Therapy in the Nursing Home Setting

  • Jerry H. Gurwitz, MD

      Affiliations

    • Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Clinic Foundation, and Fallon Community Health Plan, Worcester, Mass
    • Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
    • Corresponding Author InformationRequests for reprints should be addressed to Jerry H. Gurwitz, MD, Meyers Primary Care Institute, 630 Plantation Street, Worcester, MA 01605.
    • ,
  • Terry S. Field, DSc

      Affiliations

    • Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Clinic Foundation, and Fallon Community Health Plan, Worcester, Mass
    • ,
  • Martha J. Radford, MD

      Affiliations

    • New York University School of Medicine, New York
    • ,
  • Leslie R. Harrold, MD, MPH

      Affiliations

    • Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Clinic Foundation, and Fallon Community Health Plan, Worcester, Mass
    • ,
  • Richard Becker, MD

      Affiliations

    • Divisions of Hematology and Cardiology, Duke University School of Medicine, Durham, NC
    • ,
  • George Reed, PhD

      Affiliations

    • Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Clinic Foundation, and Fallon Community Health Plan, Worcester, Mass
    • ,
  • Kristin DeBellis, PharmD

      Affiliations

    • Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Clinic Foundation, and Fallon Community Health Plan, Worcester, Mass
    • ,
  • Jason Moldoff, BA

      Affiliations

    • Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Clinic Foundation, and Fallon Community Health Plan, Worcester, Mass
    • ,
  • Nancy Verzier, MSN, RN

      Affiliations

    • Qualidigm, Inc, Middletown, Conn.

References 

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  2. Gurwitz JH, Monette J, Rochon PA, Eckler MA, Avorn J. Atrial fibrillation and stroke prevention with warfarin in the long-term care setting. Arch Intern Med. 1997;157:978–984
  3. McCormick D, Gurwitz JH, Goldberg RJ, Ansell J. Long-term anticoagulation therapy for atrial fibrillation in elderly patients: efficacy, risk, and current patterns of use. J Thromb Thrombolysis. 1999;7:157–163
  4. Gurwitz JH, Avorn J, Ross-Degnan D, Choodnovskiy I, Ansell J. Aging and the anticoagulant response to warfarin therapy. Ann Intern Med. 1992;116:901–904
  5. Gurewich V. Ximelagatran—promises and concerns. JAMA. 2005;293:736–739
  6. Gurwitz JH, Field TS, Avorn J, et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med. 2000;109:87–94
  7. Gurwitz JH, Field TS, Judge J, et al. The incidence of adverse drug events in two large academic long-term care facilities. Am J Med. 2005;118:251–258
  8. Jones A. The National Nursing Home Survey: 1999 Summary (National Center for Health Statistics). Vital Health Stat. 2002;13:152
  9. Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289:1107–1116
  10. Bates DW, Cullen DJ, Laird N, et al. ADE Prevention Study Group Incidence of adverse drug events and potential adverse drug events implications for prevention. JAMA. 1995;274:29–34
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  13. Hylek E, Singer DE. Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med. 1994;120:897–902
  14. Fang MC, Chang Y, Hylek EM, et al. Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med. 2004;141:745–752
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  19. White RH, McKittrick T, Takakuwa J, Callahan C, McDonell M, Fihn S National Consortium of Anticoagulation Clinics. Management and prognosis of life-threatening bleeding during warfarin therapy. Arch Intern Med. 1996;156:1197–1201
  20. Freedman VA, Martin LG, Schoeni RF. Recent trends in disability and functioning among older adults in the United States: a systematic review. JAMA. 2002;288:3137–3146
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  23. Rosendaal FR, Cannegieter SC, van der Meer FJM, Briet E. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost. 1993;69:236–239
  24. Rochon PA, Field TS, Bates DW, et al. Clinical application of a computerized system for physician order entry with clinical decision support to prevent adverse drug events in long-term care. CMAJ. 2006;174:52–54
  25. Knight EL, Avorn J. Quality indicators for appropriate medication use in vulnerable elders. Ann Intern Med. 2001;135:703–710
  26. Matcher DB, Samsa GP, Cohen SJ, Oddone EZ, Gurgelski AE. Improving the quality of anticoagulation of patients with atrial fibrillation in managed care organizations: results of the managing anticoagulation services trial. Am J Med. 2002;113:42–51
  27. Harrold LR, Gurwitz JH, Tate JP, et al. Physician attitudes concerning anticoagulation services in the long-term care setting. J Thromb Thromboylsis. 2002;14:59–64
  28. Rochon PA, Field TS, Bates DW, et al. Computerized physician order entry with clinical decision support in the long-term care setting: Insights from the Baycrest Centre for Geriatric Care. J Am Geriatr Soc. 2005;53:1780–1789
  29. Hylek EM, Go AS, Chang Y, et al. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med. 2003;349:1019–1026
  30. SPORTIF Executive Steering Committee for the SPORTIF V Investigators. Ximelagatran vs warfarin for stroke prevention in patients with nonvalvular atrial fibrillation (A randomized trial). JAMA. 2005;293:690–698

 Supported by a grant from the Agency for Healthcare Research and Quality (PO1HS11534), Rockville, Maryland.

PII: S0002-9343(06)01073-4

doi: 10.1016/j.amjmed.2006.07.045

The American Journal of Medicine
Volume 120, Issue 6 , Pages 539-544 , June 2007

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