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ANTICOAGULATION

Influence of Warfarin on Symptoms of Fatigue: Findings of a Randomized Trial

Associate Professor, Department of Medicine, University of Western Ontario, London, Ontario, Canada

Clive Kearon, MB PhD

Professor, Department of Medicine, McMaster University, Hamilton, Ontario

Jim A Julian, MMath

Associate Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University

James D Douketis, MD

Associate Professor, Department of Medicine, St. Joseph's Hospital, McMaster University

Christine Demers, MD

Clinical Professor, Department of Medicine, Laval University, Québec City, Québec, Canada

Philip S Wells, MD MSc

Chief, Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Ontario; Senior Scientist, Ottawa Health Research Institute, Ottawa

Alexander G Turpie, MD

Professor, Department of Medicine, McMaster University

David R Anderson, MD

Associate Professor, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

Susan R Kahn, MD

Associate Professor, Department of Medicine, McGill University, Montreal

Paul v Nguyen, MD

Associate Professor, Department of Medicine, University of Montreal, Montreal

David Green, MD PhD

Professor of Medicine, Department of Medicine, Division of Hematology/Oncology, Feinberg School of Medicine of Northwestern University, Chicago, IL

Jeannine Kassis, MD

Associate Professor, Department of Medicine, University of Montreal

William Geerts, MD

Associate Professor of Medicine, University of Toronto, Toronto, Ontario

Betsy MacKinnon, MSc

Research Co-ordinator, Henderson Research Centre, McMaster University

Jeffrey S Ginsberg, MD

Professor, Department of Medicine, McMaster University

Reprints: Dr. Kovacs, London Health Sciences Centre, 800 Commissioners Rd. E., London N6A 4G5, ON, Canada, fax 519/685-8477, michael.kovacs{at}lhsc.on.ca

BACKGROUND: Some patients develop fatigue while taking warfarin, but causality is uncertain.

OBJECTIVE: To assess whether warfarin use is associated with fatigue.

METHODS: This investigation was a substudy of a randomized double-blind trial in 13 outpatient thromboembolism clinics. Subjects who had received one month of open-label warfarin therapy for venous thromboembolism due to a transient risk factor were randomly assigned to receive warfarin or placebo for 2 months and followed for another 9 months after stopping the study drug. Fatigue was measured using a Likert scale, and change of fatigue was measured by the patient's global rating.

RESULTS: In 87 subjects, the overall ratings of fatigue were 0.1 unit lower (95% CI 0.6 units lower to 0.4 units higher) while taking warfarin. Global rating for change in fatigue intensity showed no increase of fatigue with warfarin use.

CONCLUSIONS: The short-term use of warfarin was not associated with symptoms of fatigue.

Key Words: fatigue, warfarin

Published Online, March 15, 2005. www.theannals.com, DOI 10.1345/aph.1E531