Differential associations of beta-blockers with hemorrhagic events for chronic heart failure patients on warfarin Journal Article
| Authors: | Berlowitz, D. R.; Miller, D. R.; Oliveria, S. A.; Cunningham, F.; Gomez-Caminero, A.; Rothendler, J. A. |
| Article Title: | Differential associations of beta-blockers with hemorrhagic events for chronic heart failure patients on warfarin |
| Abstract: | Purpose: Beta-blockers have many different physiologic effects that could potentially influence the risk of hemorrhagic events in chronic heart failure patients (CHF) on warfarin. We examined how different beta-blockers vary in their associated risk of a hemorrhagic event. Methods: We used databases from the Department of Veterans Affairs (VA) that contain information on medications prescribed, diagnoses, and hospitalizations. We identified patients with CHF on warfarin and either metoprolol, carvedilol, atenolol, or no beta-blocker during 1999-2001. We modeled time to first hemorrhagic event using a Cox proportional hazards model, adjusting for age, ethnicity, comorbidities, and other factors. INR levels were examined in a subsample of 3546 patients. Results: We identified 66 988 CHF patients on warfarin. Hemorrhagic events occurred in 15.3% of the sample and, in 3.8% of the sample, the hemorrhage was considered severe. Compared to patients on carvedilol, the hazards ratio for a new hemorrhagic event was 1.25 (1.17, 1.34) for no beta-blocker, 1.27 (1.18, 1.38) for atenolol, and 1.38 (1.28, 1.48) for metoprolol. No differences in INR levels were evident among the four groups. Conclusions: The risk for a hemorrhagic event among CHF patients on warfarin may be affected by beta-blocker use and varies depending on which beta-blocker is prescribed. Copyright © 2006 John Wiley & Sons, Ltd. |
| Keywords: | adult; aged; middle aged; major clinical study; gastrointestinal hemorrhage; united states; physician's practice patterns; disease association; bleeding; proportional hazards models; risk factors; data base; medical record review; risk factor; hematuria; time factors; risk assessment; chronic disease; hospitalization; disease severity; adverse drug reaction reporting systems; proportional hazards model; drug therapy, combination; heart failure; nonsteroid antiinflammatory agent; comorbidity; anticoagulants; warfarin; metoprolol; chi-square distribution; age distribution; drug utilization; epistaxis; atenolol; beta adrenergic receptor blocking agent; brain hemorrhage; carbazoles; propanolamines; ethnology; united states department of veterans affairs; hemorrhage; international normalized ratio; pharmacoepidemiology; adrenergic beta-antagonist; congestive; carvedilol; adrenergic beta-antagonists; heart failure, congestive |
| Journal Title: | Pharmacoepidemiology and Drug Safety |
| Volume: | 15 |
| Issue: | 11 |
| ISSN: | 1053-8569 |
| Publisher: | John Wiley & Sons |
| Date Published: | 2006-11-01 |
| Start Page: | 799 |
| End Page: | 807 |
| Language: | English |
| DOI: | 10.1002/pds.1301 |
| PUBMED: | 16892457 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 7" - "Export Date: 4 June 2012" - "CODEN: PDSAE" - "Source: Scopus" |
