Warfarin Class Tied to Higher Death Rate in COPD

[gerald]

This is the second study that we have seen identifying a significant increase (22% to 41%) in deaths in people with COPD who are taking Warfarin or similar "vitamin K antagonists".   Basically the drugs reduce the Vitamin K in the body and that affects the elasticity of the lungs so it will excellerate emphysema.

As the article say it is not 100% proven. However, given the severity of the effects.....

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Warfarin Class Tied to Higher Death Rate in COPD

by Ed Susman, Contributing Writer, MedPage Today
May 23, 2018

SAN DIEGO -- Patients diagnosed with chronic obstructive pulmonary disease (COPD) patients taking vitamin K antagonists (VKAs) such as warfarin for prevention of blood clots and strokes seemed to be at a greater risk of mortality than COPD patients not on oral anti-coagulants, researchers said here.

The corrected hazard ratio of mortality was significantly higher in COPD patients using VKAs compared with those who did not (HR 1.533, 95% CI 1.344-1.748, P<0.0005), reported Ianthe Piscaer, MD, of Maastricht University Medical Center in the Netherlands, and colleagues.

In addition, age, male gender, cardiovascular disease, and diabetes were significantly associated with mortality, they reported at the American Thoracic Society annual meeting.

"Our work suggests that the combination of vitamin K antagonists can be harmful in people with COPD," Piscaer told MedPage Today. "It is plausible that the underlying pathogenic mechanism are stimulation of both elastin degradation and vascular calcification by vitamin K antagonists."

While Piscaer cautioned that "our present results are currently insufficient to issue a negative advice against the use of vitamin K antagonists in patients with COPD, the [findings] should not be neglected and deserve further investigations."

Steven Lommatzsch, MD, of the National Jewish Hospital/University of Colorado Denver, agreed. He told MedPage Today that the findings were interesting but "I wouldn't change anything about my practice based on this single study. It is still way too early to make recommendations."

Piscaer's group retrospectively reviewed the records of 31,137 COPD patients at Canisius-Wilhelmina Hospital in (Nijmegen, the Netherlands) from January 2018 to April 2017. Of those, 4,184 COPD patients (53.8% men; mean age 69.8) were included, and 1,013 COPD patients used VKAs while 3,171 did not.

Almost all of the patients (97%) treated with vitamin K antagonists were diagnosed with cardiovascular disease versus 61% of those not on vitamin K antagonists. Also, about 32% of the patients on vitamin K antagonists were diagnosed with diabetes versus sixteen % of those who were not.

The mean follow-up time was 4.4 years for the non-VKA users and 3.3 years for the VKA users. During the study period, 22.1% of non-VKA users and 41.6% of VKA users died.

The researchers suggested that interaction between medication and the disease process might be responsible for the higher mortality risk.

"Elastin degradation is accelerated in COPD patients and is related to mortality," they wrote. "Vascular calcification is also enhanced and inversely related to survival in COPD. Matrix Gla protein is a Vitamin-K dependent inhibitor of arterial calcification and elastin degradation. Vitamin K antagonists inhibit Vitamin K recycling, thereby inducing Vitamin K deficiency leading to insufficient Matrix Gla protein activation, and, consequently promotion of both arterial calcification and elastin degradation."

Lommatzsch, who was not involved in the study, said the researchers need "to drill down ... and find out why this is this trend." He added that that knowing the cause of death in the patients -- "was it bleeding or something else?" -- could help identify why there is a relationship between vitamin K antagonists and higher mortality.

"I would wait for more publications on this situation before I would take a well-controlled patient off vitamin K therapy," he said.

www.medpagetoday.com/meetingcoverage/ats/73063

This ties in with this earlier entry

philns.proboards.com/thread/14873/vitamin-deficiency-link-lung-heart

[jade]

Frightening.

[gnott]

Purely anecdotal, and a medically unqualified opinion, BUT I believe that the whole range of atrial fibrillation, anti-clotting, anti-stroke drugs are dangerous for those with advanced COPD.

I have had several acquaintances almost die while on Warfarin from excessive bleeding. Another on XARELTO - Maybe - not so sure as they had just started and were taking other NSAIDs.

ELIQUIS almost killed me - coughing up and choking on blood for 2 days till they got it under control.

If one is prescribed them - First, monitor yourself very closely - first sign of trouble (a long list is included) call or go in. Don't even think twice about it. (A major problem with most is not only can taking it be a problem, BUT to suddenly STOP taking it can also be an issue.

Second, review and carefully record ANY secondary drugs, OTC, or supplements you may decide to take - everything from harmless anti-acids to Aunt Ellen's green tea.

In spite of what they say, I'm not convinced that cardiologists and pulmonologists actually talk to each other. Smile.

But in any case it backs up my Best Advice - if one has COPD - DO NOT develop another comorbidity. If possible stick to only ONE disease at a time!

:-)

But again. I'm not medically qualified and can be ignored. But make sure you have a good discussion with your doctor/s.

[gerald]

XARELTO is dangerous.   Within 4 hours of taking it I ended up with a nose bleed that took about 3 hours to stop.   I tried to continue taking it but had to stop it after a week.  I started to show signs of internal bleeding and it took months for that to clear up.

[gnott]

That was identical to my bout with Eliquis. And thankfully caught in time. I wasn't as smart. (That's why my advice - always pass along good advice, as it does the original recipient no good what so ever. Smile)

First off, getting prescribed, in the current medical climate, seemed the right thing to do - I have always had occasional bouts of cardiac arrhythmia (irregular heartbeat), but was starting to come more frequently and last longer. I have a history of arterial heart disease, thus combined with over 70 and I officially entered the "High Risk Stroke Zone". When that happens doctors don't even think -> they automatically grab a pad for a 'blood thinner'.

I started getting mild nosebleeds, nothing new because of the drying from Oxygen and change in seasons, but "Odd" as more frequent and lasting longer. Hmm? So did I do anything? No.

Then occasionally I would cough up an odd glob of dark yellow with a old blood clot. Probably just an old clot from a nosebleed that got caught in my throat, right? Did I do anything? Of course not.

Then I coughed up the occasional fresher looking clot. Spooked me, but only one every day or two. Figured there might be something wrong with my hose/humidifier. Still assumed related to nasal bleeding. Made a note to say something next visit. ...

Then bang, woke up 4 am Saturday morning coughing up blood non-stop. (Note: Nothing important ever happens during normal workweek business hours.) Finally No debate - I went in.

As hindsight is always 20/20 - I now exactly where I went wrong.  I was STUPID! So I say again. If anyone is on these meds - at the FIRST sign of ANYTHING ODD - CALL OR GO IN.