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Anticoagulation, 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...
October 18, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
Isabel López, Estela Sangüesa, Yves Vancraenendonck, Estefanía Zuriaga, María Pilar Ribate, Cristina Belén García
Vitamin K antagonists are highly effective antithrombotic drugs. However, appropriate dosing is difficult to establish owing to its narrow therapeutic window as well as widespread inter- and intra-individual variability in dosage. Compared with dosing solely based on clinical information, pharmacogenetics can help improve the therapy with coumarins by decreasing the time to reach a stable dose and reducing the risk of bleeding. Most of the studies about genotyping of patients using vitamin K antagonists have focused on predicting the stable dose...
October 14, 2016: Drug Metabolism and Personalized Therapy
(no author information available yet)
Updated competency framework for all prescribers ● The risks of under-prescribing in older patients ● Self-monitoring and self-management of oral anticoagulation ● Role of sunscreen in preventing basal cell and squamous cell skin cancers ● Tech-based weight-loss intervention ● NICE guidance on NAFLD ● Modest improvement in sinus symptoms with nasal irrigation ● Exercise to offset the detrimental effects of sedentary habits.
October 2016: Drug and Therapeutics Bulletin
Y C Zhang, Y T Li, Y F Fan, Q Fang, H Y Fu, G H Xie, K Hu
Objective: To evaluate the effects of traditional monitoring and self-monitoring in patients who take the oral anticoagulation medicine after mechanical valve replacement surgical operations. Methods: A great number of Chinese and English literatures about this subject were investigated in detail, and these literatures were selected from the Cochrane Central Register of Controlled Trials, EMBase, MEDLINE, Web of Knowledge, CNKI, CBM, VIP, and WanFang Data. It should be noted that all of the literatures were published before October, 2015...
October 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
E Tamayo Aguirre, A Galo-Anza, O Dorronsoro-Barandiaran, E Uranga-Saez Del Burgo, A Ostiza Irigoyen, A Garcia-Carro, I Lopez-Fernandez, N Colera, P Saez-Garbayo, I Tamayo-Uria
BACKGROUND: Self-management may be an option to monitor oral anticoagulant therapy in health systems, but before recommending it, we need to assess patients' ability to take on this task. The purpose of the study was to describe patients' ability to self-manage and associated factors. METHODS: This was a 3-year prospective quasi-experimental study with a control group. Overall, 333 patients on anticoagulant therapy from seven primary care health centres of the Basque Health Service were included in the intervention group and followed up for 6 months after the intervention, assessing their ability to self-test and self-manage...
2016: BMC Cardiovascular Disorders
Christian Schaefer, Walter A Wuillemin, Alfons Kessels, Alan Jacobson, Michael Nagler
Although patient self-management (PSM) of oral anticoagulation with vitamin K antagonists is recommended for patients requiring long-term anticoagulation, important aspects are still unclear. Using data from a large international survey (n = 15 834; median age 72 years; 30·1% female), we studied predictors of poor anticoagulation control (percentage of International Normalized Ratio values within therapeutic range below 75%) and developed a simple prediction model. The following variables were identified as risk factors for poor anticoagulation control and included in the final model: higher intensity of therapeutic range (odds ratio [OR] on every level 1·9; 95% confidence interval [CI] 1·8-2·0), long intervals between measurements (>14 d; 1·5; 95% CI 1·3-1·7), female sex (OR 1·3; 95% CI 1·2-1·4), and management other than PSM (OR 1·4; 95% CI 1·2-1·6)...
July 29, 2016: British Journal of Haematology
A M H P van den Besselaar, Joseph S Biedermann, Felix J M van der Meer, Henk J Adriaansen, Frank W G Leebeek, Marieke J H A Kruip
Patients receiving vitamin K-antagonists are monitored by regular assessment of the International Normalized Ratio (INR). There are two popular methods for therapeutic control of anticoagulation in patient groups: 1) Time in Therapeutic Range (TTR) assessed by linear interpolation of successive INR measurements; 2) the cross-sectional proportion (CSP) of all patients' last INRs within range. The purpose of the present study is to compare the two methods using data from 53 Dutch Thrombosis Centres and to develop a semi-quantitative model for TTR based on different types of INR change...
September 27, 2016: Thrombosis and Haemostasis
Carl J Heneghan, Josep M Garcia-Alamino, Elizabeth A Spencer, Alison M Ward, Rafael Perera, Clare Bankhead, Pablo Alonso-Coello, David Fitzmaurice, Kamal R Mahtani, Igho J Onakpoya
BACKGROUND: The introduction of point-of-care devices for the management of patients on oral anticoagulation allows self-testing by the patient at home. Patients who self-test can either adjust their medication according to a pre-determined dose-INR (international normalized ratio) schedule (self-management), or they can call a clinic to be told the appropriate dose adjustment (self-monitoring). Increasing evidence suggests self-testing of oral anticoagulant therapy is equal to or better than standard monitoring...
2016: Cochrane Database of Systematic Reviews
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
Jelena Stevanović, Maarten J Postma, Hoa H Le
BACKGROUND: Patient self-testing (PST) and/or patient self-management (PSM) might provide better coagulation care than monitoring at specialized anticoagulation centers. Yet, it remains an underused strategy in the Netherlands. METHODS: Budget-impact analyses of current and new market-share scenarios of PST and/or PSM compared with monitoring at specialized centers were performed for a national cohort of 260,338 patients requiring long-term anticoagulation testing...
June 2016: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Donatella Radini, Gioia Sola, Nadia Zeriali, Eliana Grande, Franco Humar, Luigi Tarantini, Giovanni Pulignano, Kira Stellato, Giulia Barbati, Andrea Di Lenarda
BACKGROUND: Cardiovascular diseases are the first cause of death worldwide. In the last decades, therapeutic advances have determined an increase in survival rates, with a subsequent rise in the number of elderly people suffering from chronic cardiovascular diseases and associated comorbidities requiring comprehensive, team-based multidisciplinary care. The aim of this study is to describe the organization, purposes and activities of a nurse-led cardiology clinic. METHODS: Between November 1, 2009 and October 31, 2014, the nurse-led clinics located within our Cardiology Outpatient Center provided care to 2081 out of 26 057 patients (8%) with complex healthcare needs, high cardiovascular risk and/or specific therapeutic indications or needs for reassessment; 1875 of these patients received nurse-led interventions: 451 (21...
May 2016: Giornale Italiano di Cardiologia
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
Nicole Lowres, Georgina Mulcahy, Robyn Gallagher, Saul Ben Freedman, David Marshman, Ann Kirkness, Jessica Orchard, Lis Neubeck
OBJECTIVES: Postoperative atrial fibrillation (POAF) occurs in 25-40% of patients following cardiac surgery, and is associated with a significant increased risk of stroke and mortality. Routine surveillance is not performed post-discharge; however, recurrence of POAF can occur in up to 30% of patients discharged in sinus rhythm. This study aimed to determine the feasibility of patients self-monitoring with an iPhone handheld electrocardiogram (iECG) to identify recurrence of POAF in the post-discharge period following cardiac surgery...
July 2016: European Journal of Cardio-thoracic Surgery
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
J S Biedermann, N van Rein, A M H P van den Besselaar, P N Buhre, M P M de Maat, F J M van der Meer, F W G Leebeek, M J H A Kruip
BACKGROUND: Point-of-care (POC) international normalized ratio (INR) monitoring by healthcare professionals could eliminate the need for venous blood sampling in non-self-monitoring (NSM) patients on vitamin K antagonists (VKA). However, few studies have investigated the impact of POC INR monitoring on the quality of treatment in these patients and real-world data on this issue are lacking. OBJECTIVES: To investigate the safety, efficacy and quality of anticoagulant control during POC INR monitoring as compared with laboratory INR monitoring in NSM patients...
April 2016: Journal of Thrombosis and Haemostasis: JTH
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
I Locatelli, I Marjanovic, A Janzic
No abstract text is available yet for this article.
November 2015: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
A K Samadoulougou, D T Naibe, D G Mandi, E Kabore, G R C Millogo, N V Yameogo, J K Kologo, A T Tall, B J Y Toguyeni, P Zabsonre
INTRODUCTION: Vitamin K antagonists (VKA), the most widely prescribed oral anticoagulant therapy, represent a major public health problem by the adverse events related to their use. The aim of this study was to clarify the level of knowledge that patients have about the management of their oral anticoagulant treatment. PATIENTS AND METHODS: This was a descriptive cross-sectional study performed at Yalgado Ouedraogo university Hospital, over a period of three months starting from March 1st to May 31st 2012...
September 2015: Annales de Cardiologie et D'angéiologie
Lana A Castellucci, Joseph Shaw, Katrien van der Salm, Petra Erkens, Gregoire Le Gal, William Petrcich, Marc Carrier
BACKGROUND: Direct oral anticoagulants (DOACs) are used for treatment of venous thromboembolism (VTE) and stroke prevention in atrial fibrillation (AF). Given the shorter half-life and lack of laboratory monitoring compared to vitamin-K antagonists (VKAs), adequate adherence to DOACs is important. Reported anticoagulation adherence is unclear in clinical practice. OBJECTIVES: To assess self-reported anticoagulation adherence in a tertiary center anticoagulation clinic...
October 2015: Thrombosis Research
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