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Vulnerability to Warfarin: Could Undernutrition Be a Predictor?-Reply

David C. Anderson, MD
Arch Intern Med. 1997;157(12):1385. doi:10.1001/archinte.1997.00440330129016.
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The questions posed by Lehmann relate to the mechanism or mechanisms behind a correlation between age and intracranial bleeding complications in patients taking warfarin in the Stroke Prevention in Atrial Fibrillation study.1 For all bleeding sites, the hemorrhage rate was correlated in multivariate analysis not only with age but also with taking multiple drugs and both fluctuation and intensity of the anticoagulant effect. For intracranial events alone, there were too few events (18 total, 11 intraparenchymal) to perform multivariate analysis. Only age and blood pressure were correlated with bleeding in univariate analysis. Lehmann surmises that a lower body mass index is a surrogate for poor nutrition, reduced vitamin K intake, and, consequently, enhanced effect of warfarin. Includingfluctuation and intensity of anticoagulation agents themselves in the multivariate model for bleeding at all sites gets at the final effect of this postulated sequence of events more directly. That age still emerges


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