Does heart failure exacerbation increase response to warfarin?A critical review of the literature

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Abstract
Background: Numerous factors, such as other drugs, diet, and age, are well documented as altering response to warfarin. Less attention has been focused on the effect of disease states on the response to oral anticoagulants. Decompensated heart failure is reported to increase response to warfarin, but documentation is limited.Objective: The purpose of this review is to critically examine the evidence of a possible effect of heart failure exacerbations on response to warfarin.Research design and methods: A literature search was completed of the last 60 years using several databases, including PubMed, MEDLINE, EMBASE, and SCOPUS. Key terms in our search included ‘warfarin’ AND ‘heart failure’ and ‘heart failure exacerbation’ (or ‘decompensated heart failure’) AND ‘effect on warfarin’. When relevant citations were found, the references cited by those authors were checked.Results: Several reports from 1946–1989 suggested that decompensated heart failure increases response to oral anticoagulants. Unfort...

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