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Prevention of Bleeding in Older Patients Taking Warfarin
- Rebecca J. Beyth, MD, MS; and
- C. Seth Landefeld, MD
- Baylor College of Medicine; Houston TX, 77030 (Beyth) University of California, San Francisco; San Francisco CA, 94118 (Landefeld)
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IN RESPONSE:
We appreciate the comments of Dr. Spyropoulos and agree that there is compelling evidence of the benefits of specialized programs that coordinate management of anticoagulant therapy over “usual care” (1). In addition to the health benefits, the potential economic benefits of an organized process of care for anticoagulant therapy have been noted (2). Since we did not have a nurse- or pharmacist-managed AMS available at our institution, we cannot make any direct comparisons between our intervention and such a management service.
Regarding Dr. Kajubi's comments, we did not routinely measure hematocrit levels in our study, and the portable monitors we used measured only the INR. As noted in our study and others (3), most anticoagulant-related bleeding is gastrointestinal. Furthermore, occult upper gastrointestinal lesions are often “unmasked” when patients receive anticoagulant therapy (4, 5). In contrast, specific causes of lower gastrointestinal bleeding during anticoagulant therapy are identified less often. Before routinely including fecal occult blood testing in the management of all patients treated with long-term anticoagulant therapy, its potential health and economic benefits should be formally studied.
C. Seth Landefeld, MD
University of California, San Francisco
San Francisco CA, 94118
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
