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communication strategies warfarin

Young Woong Kim, Ho Jin Kim, Min Ho Ju, Jae Won Lee
Left atrial appendage (LAA) aneurysm is a rare, pathologic condition that may lead to atrial tachyarrhythmia or thromboembolic events. A 49-year-old man presented with aggravated palpitation and dizziness. He suffered from refractory atrial fibrillation despite a previous history of radiofrequency catheter ablation. Echocardiography revealed a 57-mm LAA aneurysm. Surgical ablation was performed through a right mini-thoracotomy, and the LAA aneurysm was obliterated with a 50-mm AtriClip (Atricure Inc., Westchester, OH, USA)...
April 2018: Korean Journal of Thoracic and Cardiovascular Surgery
Silvia Ussai, Riccardo Petelin, Antonio Giordano, Mario Malinconico, Donatella Cirillo, Francesca Pentimalli
BACKGROUND: When a patient concomitantly uses two or more drugs, a drug-drug interaction (DDI) can possibly occur, potentially leading to an increased or decreased clinical effect of a given treatment. Cancer patients are at high risk of such interactions because they commonly receive multiple medications. Moreover, most cancer patients are elderly and require additional medications for comorbidities. Aim of this preliminary observational study was to evaluate the incidence of well known and established DDIs in a cohort of cancer outpatients undergoing multiple treatments...
2015: Journal of Experimental & Clinical Cancer Research: CR
Bruce Sheldon Stambler, Leonard M Ngunga
Health care in Sub-Saharan Africa is being challenged by a double burden of disease as lifestyle diseases common in the developed world, such as stroke and atrial fibrillation (AF), increase, while, simultaneously, health issues of the developing world in terms of communicable disease persist. The prevalence of AF is lower in Africa than in the developed world but is expected to increase significantly over the next few decades. Patients with AF in Africa tend to be younger and have a higher prevalence of rheumatic valvular heart disease than patients with AF in other regions...
2015: International Journal of General Medicine
Paul R Daniels
The use of oral anticoagulants is becoming increasingly common. For many years warfarin was the main oral anticoagulant available, but therapeutic options have expanded with the introduction of oral direct thrombin (dabigatran) and factor Xa inhibitors (apixaban, rivaroxaban, and edoxaban). Management of patients taking any oral anticoagulant in the peri-procedural period poses a challenge to medical and surgical providers because of the competing risks of thrombosis and hemorrhage. Bridging therapy has been used to minimize time without anticoagulation when warfarin is interrupted for invasive procedures, but validated strategies based on high quality data are lacking...
July 14, 2015: BMJ: British Medical Journal
Sabrina Anticoli, Francesca Romana Pezzella, Antonio Siniscalchi, Luca Gallelli, Maria Cristina Bravi
BACKGROUND: Pulmonary arteriovenous malformation (PAVM) is an abnormal communication between pulmonary arteries and veins responsible for right-to-left shunting that could induce the development of embolic stroke. SUMMARY: We describe an 82-year-old woman without history of respiratory or neurological diseases, who presented at our observation unit with acute onset of cerebral ischemia. Clinical, laboratory and radiological findings diagnosed a PAVM. KEY MESSAGES: Usually, endovascular procedures based on embolization or, alternatively, surgery represent the recommended treatment...
January 2015: Interventional Neurology
Tatjana S Potpara, Laurent Pison, Torben B Larsen, Heidi Estner, Antonio Madrid, Carina Blomström-Lundqvist
This European Heart Rhythm (EHRA) Scientific Initiatives Committee EP Wire Survey aimed at exploring the common practices in approaching patients with atrial fibrillation (AF) and informing them about their risk profiles and available therapies in Europe. In the majority of 53 responding centres, patients were seen by cardiologists (86.8%) or arrhythmologists (64.2%). First- and follow-up visits most commonly lasted 21-30 and 11-20 min (41.5 and 69.8% of centres, respectively). In most centres (80.2%) stroke and bleeding risk had the highest priority for discussion with AF patients; 50...
March 2015: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Edward P Armstrong, Sharon M Wang, Lisa E Hines, Bimal V Patel, R Scott Leslie, Daniel C Malone
BACKGROUND: Health systems have developed interventions to reduce harm associated with drug-drug interactions. Pharmacy benefit managers are in an important position to identify the coprescribing of medications known to interact, since they process data on a large portion of prescription claims in the United States. Electronic health records and electronic prescribing also include alerts through their systems' clinical decision support. However, limited data are available that assess prescribers' perceptions of processes that screen for potential drug-drug interactions (PDDIs)...
May 2014: Journal of Managed Care & Specialty Pharmacy
Alessandro Di Minno, Gaia Spadarella, Antonella Tufano, Domenico Prisco, Giovanni Di Minno
Medication adherence (taking drugs properly) is uncommon among patients on warfarin. Poor adherence to warfarin leads to an increase in adverse medical events, including stroke in atrial fibrillation (AF). Factors related to patients, physicians and the health system account for poor adherence. Direct oral anticoagulants (DOACs) are easier to use than warfarin, with fewer drug and food interactions and no need for routine blood monitoring. A proper use of DOACs may reduce the risk of stroke in AF. However, in clinical settings where no laboratory monitoring is needed, a poor medication adherence is common and may impact clinical outcomes...
May 2014: Thrombosis Research
Luke Ryan Elliot Bereznicki, Shane Leigh Jackson, Gregory Mark Peterson
BACKGROUND: Point-of-care international normalized ratio (INR) monitoring devices simplify warfarin management by allowing selected patients to monitor their own therapy in their homes. Patient self-testing (PST) has been shown to improve the clinical outcomes of warfarin therapy compared to usual care. OBJECTIVE: To compare management of warfarin therapy using PST combined with online supervision by physicians via a custom system with usual warfarin management, which involved laboratory testing and physician dosing...
2013: Journal of Medical Internet Research
Luke R E Bereznicki, Shane L Jackson, Wiete Kromdijk, Peter Gee, Kimbra Fitzmaurice, Bonnie J Bereznicki, Gregory M Peterson
OBJECTIVE: In aged-care facilities (ACFs) monitoring of warfarin can be logistically challenging and International Normalised Ratio (INR control) is often suboptimal. We aimed to determine whether an integrated information and communications technology system and the use of point-of-care (POC) monitors by nursing staff could improve the INR control of aged-care facility residents who take warfarin. METHODS: Nursing staff identified residents who were prescribed warfarin in participating ACFs...
February 2014: International Journal of Pharmacy Practice
Brian E Grunau, Matthew O Wiens, Kenneth K Harder
OBJECTIVE: To investigate the effectiveness of patient self-management (PSM) of anticoagulation using warfarin in a typical primary care site in Canada and to determine the feasibility of conducting a future large-scale trial in this setting. DESIGN: An 8-month pragmatic open-label randomized crossover trial. SETTING: A typical Canadian primary care practice in British Columbia. INTERVENTION: Patients were randomized to PSM or physician management for 4 months, after which allocation was reversed...
August 2011: Canadian Family Physician Médecin de Famille Canadien
Lemuel R Waitman, Ira E Phillips, Allison B McCoy, Ioana Danciu, Robert M Halpenny, Cori L Nelsen, Daniel C Johnson, John M Starmer, Josh F Peterson
BACKGROUND: High-alert medications are frequently responsible for adverse drug events and present significant hazards to inpatients, despite technical improvements in the way they are ordered, dispensed, and administered. METHODS: A real-time surveillance application was designed and implemented to enable pharmacy review of high-alert medication orders to complement existing computerized provider order entry and integrated clinical decision support systems in a tertiary care hospital...
July 2011: Joint Commission Journal on Quality and Patient Safety
Michael D Howell
Mr A, a previously healthy 37-year-old man, was diagnosed as having Prinzmetal angina and a hypercoagulable state 3 years ago after an ST-elevation myocardial infarction. Now, his cardiologist is moving and Mr A must select a new physician and health system. Geographic relocation, insurance changes, and other events force millions in the United States to change physicians and hospitals every year. Mr A should begin by choosing a primary care physician, since continuity and coordination of care improves outcomes...
December 2, 2009: JAMA: the Journal of the American Medical Association
Margaret C Fang, Praveen Panguluri, Edward L Machtinger, Dean Schillinger
OBJECTIVE: Warfarin is a medication commonly prescribed to prevent strokes associated with certain medical conditions such as atrial fibrillation; however, little is known about how people taking warfarin perceive the goal of therapy and how they describe strokes. We assessed the stroke-related health literacy of anticoagulated patients to inform ways in which to improve health communication among people taking warfarin. METHODS: We conducted a mixed-methods study of an ethnically and linguistically diverse sample of people taking warfarin to prevent stroke (N=183) and measured literacy using the short-form Test of Functional Health Literacy in Adults...
June 2009: Patient Education and Counseling
Martin O'Donnell, Clive Kearon
Based on an individual assessment of risk factors for arterial or venous thrombosis and the risk of postoperative bleeding, this article outlines the preoperative and postoperative approach to anticoagulant management. Preceding this is a brief description of the therapies most commonly used in the perioperative period. The prevention of arterial thromboembolism is considered separately from the prevention of venous thrombosis. Perioperative management of anticoagulation can cause anxiety for patients, surgeons, anesthetists, and those who manage long-term anticoagulant therapy...
May 2008: Cardiology Clinics
A Bhasale, G Miller, H Britt, S Reid
The incident Monitoring in General Practice Project began as an initiative of the Professional Indemnity Review. Anonymous data from general practitioners about unintended, and possibly adverse events were collected in order to develop preventive strategies that might ultimately increase patient safety and therefore reduce litigation. Feedback and sharing of experiences and ideas about these events, possible management strategies or the project as a whole are invited from the readers.
July 1996: Australian Family Physician
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