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Warfarin self-monitoring

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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Qiu-lin Chen, Li Dong, Yi-jun Dong, Shu-lin Zhao, Bo Fu, Yu-qing Wang, Hong Jiang
BACKGROUND: International normalized ratio (INR) self-testing can improve the management of anticoagulation therapy with warfarin for the patients following mechanical heart valve replacement. Several reviews and studies have demonstrated self-management as an option to improve patient's outcome considerably after mechanical heart valve replacement. We sought to analyze the security, economy and discuss the prospect of self-testing of anticoagulation therapy in patients following mechanical heart valve replacement in China, and evaluate the accuracy and stability of CoaguChek XS portable INR-testing device...
2015: Journal of Cardiothoracic Surgery
Matthew J Witry, William R Doucette
BACKGROUND: Community pharmacists are well positioned to identify and resolve medication related problems associated with chronic medication use during prescription dispensing, a process referred to as medication monitoring. Pharmacists need feedback about patient medication experiences to engage in effective monitoring, but the pharmacist's decision making process for when to ask questions to solicit this information from patients has not been established. OBJECTIVES: Identify significant factors contributing to a community pharmacist's likelihood to ask medication monitoring questions at the time of refill...
September 2015: Research in Social & Administrative Pharmacy: RSAP
Guilherme Suarez-Kurtz, Mariana R Botton
INTRODUCTION: Coumarin vitamin K antagonists are the mainstay of anticoagulant therapy in atrial fibrillation, prosthetic heart valves and thromboembolic conditions. Concerns with these drugs include large inter-individual variability in dose requirements, narrow therapeutic index and need to monitor prothrombin time repeatedly. AREAS COVERED: Pharmacogenetic studies and dosing algorithms for warfarin and phenprocoumon. EXPERT OPINION: Gene candidate studies in Brazilian patients verified consistently the association of warfarin and pheprocoumon stable dose requirements with CYP2C9 and VKORC1 polymorphisms, and minor or no influence of other pharmacogenes (e...
January 2015: Expert Opinion on Drug Metabolism & Toxicology
Emily M Hawes, Anthony J Viera
For patients with acute venous thromboembolism treated with warfarin, parenteral anticoagulation should be continued for a minimum of 5 days and until the international normalized ratio (INR) is 2 or greater for at least 24 hours. Early initiation of warfarin therapy is recommended. The goal therapeutic INR range for patients treated with warfarin is most commonly 2 to 3. During maintenance warfarin therapy, validated decision-support tools should be used to guide dosing. For patients with stable INRs, frequency of INR testing can be extended from every 4 weeks to up to 12 weeks...
July 2014: FP Essentials
Amanda Howard-Thompson, Alexis Luckey, Christa George, Beth A Choby, Timothy H Self
Background. Hyperthyroidism causes an increased hypoprothrombinemic response to warfarin anticoagulation. Previous studies have demonstrated that patients with hyperthyroidism require lower dosages of warfarin to achieve a therapeutic effect. As hyperthyroidism is treated and euthyroidism is approached, patients may require increasing warfarin dosages to maintain appropriate anticoagulation. We describe a patient's varying response to warfarin during treatment of Graves' disease. Case Presentation. A 48-year-old African American female presented to the emergency room with tachycardia, new onset bilateral lower extremity edema, gradual weight loss, palpable goiter, and generalized sweating over the prior 4 months...
2014: Case Reports in Medicine
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