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Warfarin self-monitoring

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https://www.readbyqxmd.com/read/29025143/cost-effectiveness-of-the-pharmacist-assisted-warfarin-monitoring-program-at-a-medical-center-in-taiwan
#1
Jen-Yu Chang, Chi-Chuan Wang, Hao-Cheng Kang, Li-Jiuan Shen, Chih-Fen Huang
Objective: To investigate the cost-effectiveness of the first patient self-paying pharmacist-assisted warfarin monitoring (PAWM) program in Taiwan. Design: A Markov model with a 1-month cycle length and a 20-year time horizon was employed in this study. The model is composed of the following eight states: three no-event states (i.e. 'subtherapeutic,' 'within therapeutic' and 'supratherapeutic' states), two serious adverse events (AEs) (i.e. bleeding and thromboembolism), two sequelae states and death...
August 22, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/28869793/the-relationship-between-knowledge-health-literacy-and-adherence-among-patients-taking-oral-anticoagulants-for-stroke-thromboprophylaxis-in-atrial-fibrillation
#2
Chanelle A Rolls, Kehinde O Obamiro, Leanne Chalmers, Luke R E Bereznicki
BACKGROUND: Patients' knowledge regarding their oral anticoagulant (OAC) treatment for stroke prevention in atrial fibrillation (AF), their level of medication adherence and health literacy are known to affect treatment outcomes. However, contemporary data regarding the relationships between these variables are lacking. OBJECTIVE: To investigate the relationships between anticoagulant knowledge, health literacy and self-reported adherence in patients taking warfarin and the directly acting oral anticoagulants...
September 4, 2017: Cardiovascular Therapeutics
https://www.readbyqxmd.com/read/28771571/optical-sensing-of-anticoagulation-status-towards-point-of-care-coagulation-testing
#3
Diane M Tshikudi, Markandey M Tripathi, Zeinab Hajjarian, Elizabeth M Van Cott, Seemantini K Nadkarni
Anticoagulant overdose is associated with major bleeding complications. Rapid coagulation sensing may ensure safe and accurate anticoagulant dosing and reduce bleeding risk. Here, we report the novel use of Laser Speckle Rheology (LSR) for measuring anticoagulation and haemodilution status in whole blood. In the LSR approach, blood from 12 patients and 4 swine was placed in disposable cartridges and time-varying intensity fluctuations of laser speckle patterns were measured to quantify the viscoelastic modulus during clotting...
2017: PloS One
https://www.readbyqxmd.com/read/28709455/barriers-and-facilitators-to-reducing-frequent-laboratory-testing-for-patients-who-are-stable-on-warfarin-a-mixed-methods-study-of-de-implementation-in-five-anticoagulation-clinics
#4
Geoffrey D Barnes, Sevan Misirliyan, Scott Kaatz, Elizabeth A Jackson, Brian Haymart, Eva Kline-Rogers, Jay Kozlowski, Gregory Krol, James B Froehlich, Anne Sales
BACKGROUND: Patients on chronic warfarin therapy require regular laboratory monitoring to safely manage warfarin. Recent studies have challenged the need for routine monthly blood draws in the most stable warfarin-treated patients, suggesting the safety of less frequent laboratory testing (up to every 12 weeks). De-implementation efforts aim to reduce the use of low-value clinical practices. To explore barriers and facilitators of a de-implementation effort to reduce the use of frequent laboratory tests for patients with stable warfarin management in nurse/pharmacist-run anticoagulation clinics, we performed a mixed-methods study conducted within a state-wide collaborative quality improvement collaborative...
July 14, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28695382/point-of-care-coagulation-monitoring-first-clinical-experience-using-a-paper-based-lateral-flow-diagnostic%C3%A2-device
#5
Michael A Hegener, Hua Li, Daewoo Han, Andrew J Steckl, Giovanni M Pauletti
Vitamin K antagonists such as warfarin are the most widely used class of oral anticoagulants. Due to a narrow therapeutic window, patients on warfarin require regular monitoring. Self-testing using point-of-care (POC) diagnostic devices is available, but cost makes this monitoring method beyond reach for many. The main objective of this research was to assess the clinical utility of a low-cost, paper-based lateral flow POC diagnostic device developed for anticoagulation monitoring without the need for a separate electronic reader...
September 2017: Biomedical Microdevices
https://www.readbyqxmd.com/read/27754958/point-of-care-testing-inr-an-overview
#6
REVIEW
Doris Barcellona, Lara Fenu, Francesco Marongiu
Oral anticoagulant therapies with the anti-vitamin K drugs (AVK), warfarin, acenocoumarol and phenprocoumon, are employed in primary and secondary anti-thrombotic prophylaxis in patients with venous thromboembolism, atrial fibrillation and cardiac mechanical valves. However, a monitoring test such as the International Normalized Ratio (INR) is required. The periodic monitoring of this therapy entails discomfort for the patients. Telemedicine and telecare can provide significant aid in the management of this therapy allowing patients to perform the test at home or anywhere else with a portable device, i...
May 1, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/27328684/evaluation-of-the-role-and-usefulness-of-a-pharmacist-outpatient-service-for-patients-undergoing-monotherapy-with-oral-anti-cancer-agents
#7
Michio Kimura, Makiko Go, Mina Iwai, Eiseki Usami, Hitomi Teramachi, Tomoaki Yoshimura
INTRODUCTION: When rapid feedback to physicians must be provided, e.g. monitoring therapy with the oral anticoagulant warfarin or providing therapeutic support for patients undergoing cancer chemotherapy, the involvement of pharmacists is required for outpatients. We launched a pharmacist outpatient service for patients with cancer taking oral anti-cancer agents. We evaluated the role and usefulness of the pharmacist outpatient service for these patients undergoing oral monotherapy with anti-cancer agents...
June 20, 2016: Journal of Oncology Pharmacy Practice
https://www.readbyqxmd.com/read/27326234/prevalence-of-atrial-fibrillation-in-an-urban-population-in-india-the-nagpur-pilot-study
#8
Daljeet Kaur Saggu, Gomathi Sundar, Sandeep G Nair, Varun C Bhargava, Krishnamohan Lalukota, Sridevi Chennapragada, Calambur Narasimhan, Sumeet S Chugh
OBJECTIVES: Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice with major public health impact mainly due to the increased risk of stroke. The recent Global Burden of Disease Study reported a lack of prevalence data from India. Our goal was to conduct a pilot study to evaluate the feasibility of assessing AF prevalence and stroke prophylaxis in an urban Indian community. METHODS: A screening camp was conducted in Nagpur, India, that evaluated adults aged ≥18 years...
2016: Heart Asia
https://www.readbyqxmd.com/read/27251646/patient-satisfaction-with-extended-interval-warfarin-monitoring
#9
Nicholas W Carris, Andrew Y Hwang, Steven M Smith, James R Taylor, Karen Sando, Jason Powell, Eric I Rosenberg, Marc S Zumberg, John G Gums, Eric A Dietrich, Katherine Vogel Anderson
Extended-interval monitoring of warfarin has been proposed to reduce follow-up burden and improve patient satisfaction. We aimed to make an initial assessment of anticoagulation satisfaction before and after an extended-interval warfarin monitoring intervention. We conducted a translational prospective single-arm pilot study of extended-interval warfarin monitoring in five pharmacist-managed anticoagulation clinics. Patients meeting CHEST guideline criteria for extended-interval warfarin monitoring began progressive extended-interval follow-up (6, 8, and 12 weeks thereafter)...
November 2016: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/27234663/at-home-versus-in-clinic-inr-monitoring-a-cost-utility-analysis-from-the-home-inr-study-thinrs
#10
Ciaran S Phibbs, Sean R Love, Alan K Jacobson, Robert Edson, Pon Su, Lauren Uyeda, David B Matchar
BACKGROUND: Effective management of patients using warfarin is resource-intensive, requiring frequent in-clinic testing of the international normalized ratio (INR). Patient self-testing (PST) using portable at-home INR monitoring devices has emerged as a convenient alternative. As revealed by The Home INR Study (THINRS), event rates for PST were not significantly different from those for in-clinic high-quality anticoagulation management (HQACM), and a cumulative gain in quality of life was observed for patients undergoing PST...
September 2016: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/27065202/the-journey-for-adolescents-and-young-adults-with-chronic-conditions-transitioning-to-adult-care-with-successful-warfarin-management
#11
M E Bauman, S Kuhle, A A K Bruce, L Bolster, M P Massicotte
UNLABELLED: Health transition of youth from a child-centered care model to the adult model has been recognized to be of critical importance due to the increasing numbers of children now surviving chronic conditions. A formalized transition process is required adequately assess the AYA's readiness for transition and to move towards adult care. Indefinite warfarin therapy poses challenges as warfarin is a narrow therapeutic index drug that requires frequent monitoring and attentiveness to warfarin interactions and affects...
May 2016: Thrombosis Research
https://www.readbyqxmd.com/read/26808370/safety-and-efficacy-outcomes-of-home-and-hospital-warfarin-management-within-a-pediatric-anticoagulation-clinic
#12
Sophie Jones, Siobhan McLoughlin, Dana Piovesan, Helen Savoia, Paul Monagle, Fiona Newall
The complexity of managing children with chronic disease has led to an increase in the use of long-term warfarin therapy. Time in therapeutic range (TTR) is the preferred method for determining efficacy and stability of warfarin management. This study aimed to determine the TTR achievement and incidence of adverse events among pediatric warfarin patients managed by an anticoagulation clinic over 12 months and to compare TTR achievement between patients self-testing (PST) at home and those monitored using routine methods...
April 2016: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/26648615/how-to-manage-warfarin-therapy
#13
REVIEW
Philip A Tideman, Rosy Tirimacco, Andrew St John, Gregory W Roberts
Long-term treatment with warfarin is recommended for patients with atrial fibrillation at risk of stroke and those with recurrent venous thrombosis or prosthetic heart valves. Patient education before commencing warfarin - regarding signs and symptoms of bleeding, the impact of diet, potential drug interactions and the actions to take if a dose is missed - is pivotal to successful use. Scoring systems such as the CHADS2 score are used to determine if patients with atrial fibrillation are suitable for warfarin treatment...
April 2015: Australian Prescriber
https://www.readbyqxmd.com/read/26519487/assessing-the-utility-of-an-online-registry-for-patients-monitoring-their-own-warfarin-therapy
#14
Deborah McCahon, Jennifer M Baker, Ellen T Murray, David A Fitzmaurice
AIMS: To evaluate the utility of an online self-report registry for patient self-monitoring and self-management (PSM) of warfarin therapy. METHODS: A prospective observational study of UK-based patients undertaking PSM and recording their international normalised ratio (INR) data via an online registry. Consenting participants recorded INR test dates, results and warfarin dosages using the online registry for a period of 12 months. Participants reported demographic data, disease characteristics and treatment-related adverse events and provided feedback via a survey...
April 2016: Journal of Clinical Pathology
https://www.readbyqxmd.com/read/26362472/empowared-edmonton-pediatric-warfarin-self-management-study
#15
M E Bauman, M P Massicotte, S Kuhle, S Siddons, A A K Bruce
BACKGROUND: Patient self-management (PSM) in adults is safer and more cost effective than conventional management. Warfarin is a narrow therapeutic index drug with individual patient response to changes and frequently a long-term therapy. Children and their families are proposed to be able to effectively manage their child's warfarin therapy. Increased health related quality of life is highly associated with effective therapy in patients with chronic conditions. OBJECTIVES: The aim of this study is to evaluate the safety and efficacy of PSM over time including HRQOL and variables that may influence PFU success at PSM...
November 2015: Thrombosis Research
https://www.readbyqxmd.com/read/26215871/cost-effectiveness-analysis-of-dabigatran-and-anticoagulation-monitoring-strategies-of-vitamin-k-antagonist
#16
Misericòrdia Carles, Max Brosa, Juan Carlos Souto, Josep Maria Garcia-Alamino, Gordon Guyatt, Pablo Alonso-Coello
BACKGROUND: Vitamin K antagonists are commonly used for the prevention of thromboembolic events. Patient self-monitoring of vitamin K antagonists has proved superior to usual care. Dabigatran has been shown, relative to warfarin, to reduce thromboembolic events without increasing bleeding. METHODS: We constructed a Markov model to compare vitamin K self-monitoring strategies to dabigatran including effectiveness and costs of monitoring and complications (thromboembolism and major bleeding)...
2015: BMC Health Services Research
https://www.readbyqxmd.com/read/26198584/trends-in-warfarin-monitoring-practices-among-new-york-medicare-beneficiaries-2006-2011
#17
Darren M Triller, Susan Wymer, Patrick D Meek, Elaine M Hylek, Jack E Ansell
Anticoagulation with warfarin requires frequent evaluation of the international normalized ratio (INR), and less invasive testing devices are available for use by clinicians at the point-of-care (POC) and by patients who self-test (PST). Despite commercial availability and positive results of published studies, evidence suggests that adoption of less invasive (POC/PST) testing in the United States is slow. Considering the equivalence of results and logistical advantages of POC/PST testing, slow uptake may indicate a gap in quality of care warranting evaluation and possibly intervention...
October 2015: Journal of Community Health
https://www.readbyqxmd.com/read/25905496/correlation-between-home-inr-and-core-laboratory-inr-in-patients-supported-with-continuous-flow-left-ventricular-assist-devices
#18
Marija Dionizovik-Dimanovski, Allison P Levin, Justin Fried, Kanika P Mody, Erica Simonich, Arthur Reshad Garan, Melana Yuzefpolskaya, Hiroo Takayama, Yoshifumi Naka, Paolo C Colombo, Bindu Kalesan, Nir Uriel, Ulrich P Jorde
It has been well established that patient self-testing (PST) of international normalized ratio (INR) using home monitoring devices increases the average therapeutic time and patient satisfaction. Long-term anticoagulation therapy with warfarin is used in patients with continuous-flow left ventricular assist device (CF-LVAD) to minimize the occurrence of thromboembolic events; however, PST devices have never been tested in patients with CF-LVADs. The purpose of this study was to determine the reliability of the PST device Alere INRatio 2 in patients supported with CF-LVADs...
July 2015: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/25705123/nurses-self-reported-time-estimation-of-anticoagulation-therapy-a-survey-of-warfarin-management-in-long-term-care
#19
Aarti A Patel, Winnie W Nelson
BACKGROUND: A nursing shortage in the United States has resulted in increased workloads, potentially affecting the quality of care. This situation is particularly concerning in long-term care (LTC) facilities, where residents are older, frailer, and may be receiving multiple medications for comorbidities, thus requiring a greater commitment of nurse time. We conducted a survey of LTC nurses to determine how much of their time each week is spent managing newly started and stable warfarin-treated residents...
2015: BMC Nursing
https://www.readbyqxmd.com/read/25616558/quality-of-oral-anticoagulation-with-phenprocoumon-in-regular-medical-care-and-its-potential-for-improvement-in-a-telemedicine-based-coagulation-service-results-from-the-prospective-multi-center-observational-cohort-study-thrombeval
#20
MULTICENTER STUDY
Jürgen H Prochaska, Sebastian Göbel, Karsten Keller, Meike Coldewey, Alexander Ullmann, Heidrun Lamparter, Claus Jünger, Zaid Al-Bayati, Christina Baer, Ulrich Walter, Christoph Bickel, Hugo ten Cate, Thomas Münzel, Philipp S Wild
BACKGROUND: The majority of studies on quality of oral anticoagulation (OAC) therapy with vitamin K-antagonists are performed with short-acting warfarin. Data on long-acting phenprocoumon, which is frequently used in Europe for OAC therapy and is considered to enable more stable therapy adjustment, are scarce. In this study, we aimed to assess quality of OAC therapy with phenprocoumon in regular medical care and to evaluate its potential for optimization in a telemedicine-based coagulation service...
January 23, 2015: BMC Medicine
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