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https://www.readbyqxmd.com/read/27905076/improvement-of-time-in-therapeutic-range-with-warfarin-by-pharmaceutical-intervention
#1
Alvaro Víquez-Jaikel, Victoria Hall-Ramírez, Allan Ramos-Esquivel
Background Anticoagulation therapy with warfarin is highly effective for prevention and treatment of thromboembolic disorders. Nevertheless, its management is challenging especially in developing countries, where the medical access is difficult and patient education is poor. Objective To determine the effect of pharmaceutical intervention (PI) on the time in therapeutic range (TTR) of a group of anticoagulated patients from our referral center. Method A group of consecutive outpatients previously treated by usual medical care underwent PI...
November 30, 2016: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/27864202/implementation-of-inpatient-models-of-pharmacogenetics-programs
#2
Larisa H Cavallari, Craig R Lee, Julio D Duarte, Edith A Nutescu, Kristin W Weitzel, George A Stouffer, Julie A Johnson
PURPOSE: The operational elements essential for establishing an inpatient pharmacogenetic service are reviewed, and the role of the pharmacist in the provision of genotype-guided drug therapy in pharmacogenetics programs at three institutions is highlighted. SUMMARY: Pharmacists are well positioned to assume important roles in facilitating the clinical use of genetic information to optimize drug therapy given their expertise in clinical pharmacology and therapeutics...
December 1, 2016: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/27857237/improving-the-use-and-timeliness-of-anticoagulation-reversal-for-warfarin-related-intracranial-haemorrhage
#3
Carl Hanger, John Geddes, Tim Wilkinson, Michele Lee, Scott Pearson, Andrew Butler, Krishna Badami
BACKGROUND: Warfarin-related intracranial haemorrhage (WRICH) is a life-threatening complication of warfarin use. Rapid and complete reversal of the coagulopathy is required. Reversal protocols which include prothrombin complex concentrates (PCC) are now recommended. We report on a quality improvement project to implement and refine such a protocol. METHODS: Retrospective and then prospective audits of all WRICH patients presenting to a single centre. The protocol development and subsequent refinements are described...
November 18, 2016: New Zealand Medical Journal
https://www.readbyqxmd.com/read/27729677/risk-factors-for-bleeding-in-hospitalized-patients-with-elevated-inr-no-vitamin-k-therapy-received-versus-vitamin-k-received
#4
Monique Mounce, Candace Essel, Tiffany Kim, Che Matthew Harris
BACKGROUND: Supratherapeutic international normalized ratio (INR) in patients on warfarin is a common side effect. Updated guidelines recommend against using vitamin K to correct INRs 4.5 to 10 in the absence of bleeding. The impact of compliance with updated guidelines during hospitalization has not been fully explored. METHODS: A retrospective, observational study was performed utilizing electronic medical records. The goal was to evaluate management of supratherapeutic INR values for medicine inpatients and identify differences in clinical outcomes among inpatients treated and not treated with vitamin K...
November 2015: Hospital Pharmacy
https://www.readbyqxmd.com/read/27704588/assessment-of-web-based-education-resources-informing-patients-about-stroke-prevention-in-atrial-fibrillation
#5
E Pandya, B V Bajorek
WHAT IS KNOWN AND OBJECTIVE: The importance of 'shared decision-making' is much emphasized in recent clinical guidelines regarding stroke management in atrial fibrillation (AF), more so following the inclusion of non-vitamin K oral anticoagulants (NOACs) among the treatment options. It is important that patients are navigated through balanced and unbiased information about the available treatment options, so as to understand the risk and benefits associated with the therapies, and to enable them to accordingly communicate their concerns and views with their clinicians prior to therapy selection...
October 5, 2016: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/27693910/is-the-clinical-relevance-of-drug-food-and-drug-herb-interactions-limited-to-grapefruit-juice-and-saint-john-s-wort
#6
Stéphane Mouly, Célia Lloret-Linares, Pierre-Olivier Sellier, Damien Sene, J-F Bergmann
An interaction of drug with food, herbs, and dietary supplements is usually the consequence of a physical, chemical or physiologic relationship between a drug and a product consumed as food, nutritional supplement or over-the-counter medicinal plant. The current educational review aims at reminding to the prescribing physicians that the most clinically relevant drug-food interactions may not be strictly limited to those with grapefruit juice and with the Saint John's Wort herbal extract and may be responsible for changes in drug plasma concentrations, which in turn decrease efficacy or led to sometimes life-threatening toxicity...
September 28, 2016: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/27688671/quality-of-anticoagulation-control-among-patients-with-atrial-fibrillation-an-experience-of-a-tertiary-care-center-in-saudi-arabia
#7
Sarah M Alyousif, Ahmed A Alsaileek
BACKGROUND: Atrial fibrillation (AF) is the most common chronic rhythm disorder. Patients with AF are at an increased risk of ischemic stroke. Therefore, optimal anticoagulation is essential to reduce the risk of stroke. The aim of this study was to assess the level of anticoagulation control achieved in patients with nonvalvular AF receiving medical care in a tertiary care hospital. METHODS: This was a retrospective cohort study in ambulatory care clinics at tertiary care hospital in Saudi Arabia...
October 2016: Journal of the Saudi Heart Association
https://www.readbyqxmd.com/read/27441538/assessment-of-warfarin-treatment-efficacy-by-means-of-using-coagulation-test-results-within-the-therapeutic-range
#8
P Varim, C Varim, H Ergenç, M Uyanık, S Yaylacı, M Vatan, H Gündüz
Time in Therapeutic Range (TTR) is a value used to assess the efficacy of Warfarin treatment. The aim of our study is to determine the effective INR levels and the rate of TTR in patients on Warfarin regimen due to Atrial Fibrillation (AF) or Mechanical Prosthetic Valve (MPV). A total of 94 patients (58 female, and 36 male, mean age: 64.9±11years) on Warfarin treatment due to AF or MPV with at least 10 INR levels measurements in the last 6 months were included in this retrospective study. The patients were divided into 2 groups...
June 2016: Georgian Medical News
https://www.readbyqxmd.com/read/27342960/assessment-of-psychometric-properties-of-the-brazilian-version-of-the-oral-anticoagulation-knowledge-test
#9
Marcus Fernando da Silva Praxedes, Mauro Henrique Nogueira Guimarães de Abreu, Saul Martins Paiva, Juliana Vaz de Melo Mambrini, Milena Soriano Marcolino, Maria Auxiliadora Parreiras Martins
BACKGROUND: The aim of this study was to evaluate the psychometric properties of the Brazilian version of the Oral Anticoagulation Knowledge (OAK) Test. METHODS: This study, conducted in an anticoagulation clinic, included 201 Brazilian participants aged over 18 years, who had been using warfarin for more than two months. The reliability of the instrument was evaluated by assessing internal consistency (Kuder-Richardson coefficient) and reproducibility (test-retest reliability)...
2016: Health and Quality of Life Outcomes
https://www.readbyqxmd.com/read/27317014/impact-of-a-guideline-for-the-management-of-antimicrobial-warfarin-interactions-in-the-inpatient-setting-and-across-transition-of-care
#10
Nghi B Ha, Katherine Yang, Sarah Hanigan, Brian Kurtz, Michael P Dorsch, Hannah Mak, Jerod Nagel
BACKGROUND: Drug-drug interactions (DDIs) with warfarin and antimicrobial agents are a common cause of international normalized ratio (INR) instability, which can affect the risk for bleeding and thrombotic events. OBJECTIVE: The purpose of this study was to assess the impact of a comprehensive guideline for the management of warfarin-antimicrobial DDIs across transitions of care. The guideline emphasizes improving identification of significant antimicrobial-warfarin DDIs during hospitalization, empirical warfarin dose modification based on DDI and baseline INR, patient education, documentation of the DDI, communication with outpatient providers regarding the DDI and anticipated antimicrobial stop date, and warfarin dose adjustment on discontinuation of antimicrobial...
September 2016: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/27289254/medical-complications-following-splenectomy
#11
R Buzelé, L Barbier, A Sauvanet, B Fantin
Splenectomy is attended by medical complications, principally infectious and thromboembolic; the frequency of complications varies with the conditions that led to splenectomy (hematologic splenectomy, trauma, presence of portal hypertension). Most infectious complications are caused by encapsulated bacteria (Meningococcus, Pneumococcus, Hemophilus). These occur mainly in children and somewhat less commonly in adults within the first two years following splenectomy. Post-splenectomy infections are potentially severe with overwhelming post-splenectomy infection (OPSI) and this justifies preventive measures (prophylactic antibiotics, appropriate immunizations, patient education) and demands prompt antibiotic management with third-generation cephalosporins for any post-splenectomy fever...
August 2016: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/27255713/drug-treatment-of-venous-thromboembolism-in-the-elderly
#12
REVIEW
Jir Ping Boey, Alexander Gallus
Half of all patients with acute venous thromboembolism are aged over 70 years; they then face the added hazard of an age-related increase in the incidence of major bleeding. This makes it even more important to weigh the balance of benefit and risk when considering anticoagulant treatment and treatment duration. Traditional treatment with a heparin (usually low molecular weight) followed by a vitamin K antagonist such as warfarin is effective but is often complicated, especially in the elderly. The direct-acting oral anticoagulants (DOACs), i...
July 2016: Drugs & Aging
https://www.readbyqxmd.com/read/27143951/potential-utility-of-precision-medicine-for-older-adults-with-polypharmacy-a-case-series-study
#13
Joseph Finkelstein, Carol Friedman, George Hripcsak, Manuel Cabrera
Pharmacogenomic (PGx) testing has been increasingly used to optimize drug regimens; however, its potential in older adults with polypharmacy has not been systematically studied. In this hypothesis-generating study, we employed a case series design to explore potential utility of PGx testing in older adults with polypharmacy and to highlight barriers in implementing this methodology in routine clinical practice. Three patients with concurrent chronic heart and lung disease aged 74, 78, and 83 years and whose medication regimen comprised 26, 17, and 18 drugs, correspondingly, served as cases for this study...
2016: Pharmacogenomics and Personalized Medicine
https://www.readbyqxmd.com/read/27105651/how-to-invest-in-getting-cost-effective-technologies-into-practice-a-framework-for-value-of-implementation-analysis-applied-to-novel-oral-anticoagulants
#14
Rita Faria, Simon Walker, Sophie Whyte, Simon Dixon, Stephen Palmer, Mark Sculpher
Cost-effective interventions are often implemented slowly and suboptimally in clinical practice. In such situations, a range of implementation activities may be considered to increase uptake. A framework is proposed to use cost-effectiveness analysis to inform decisions on how best to invest in implementation activities. This framework addresses 2 key issues: 1) how to account for changes in utilization in the future in the absence of implementation activities; and 2) how to prioritize implementation efforts between subgroups...
April 22, 2016: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/27022381/evaluation-of-knowledge-of-health-care-professionals-on-warfarin-interactions-with-drug-and-herb-medicinal-in-central-saudi-arabia
#15
Mohamed N Al-Arifi, Syed Wajid, Nawaf K Al-Manie, Faisal M Al-Saker, Salmeen D Babelgaith, Yousif A Asiri, Ibrahim Sales
OBJECTIVES: To evaluate health care professionals' knowledge on warfarin interactions with drugs and herbs. METHODS: A self-administered questionnaire was developed to assess health care professionals' knowledge on warfarin interactions with drug and herb. Respondents were asked to classify 15 drugs that may effect on warfarin action as "enhance", "inhibit ", "no effect". The study sample involved health care professionals (physicians, pharmacists and nurses) from king Salman hospital, Saudi Arabia...
January 2016: Pakistan Journal of Medical Sciences Quarterly
https://www.readbyqxmd.com/read/26962786/interaction-between-dietary-vitamin-k-intake-and-anticoagulation-by-vitamin-k-antagonists-is-it-really-true-a-systematic-review
#16
Francesco Violi, Gregory Yh Lip, Pasquale Pignatelli, Daniele Pastori
Educational advice is often given to patients starting treatment with vitamin K Antagonists (VKAs). A great emphasis is made on nutritional information. Common belief is that dietary vitamin K intake could counteract the anticoagulant effect by VKAs and for many years, patients have been discouraged to consume vitamin-K-rich foods, such as green leafy vegetables.The objective of this study is to summarize the current evidence supporting the putative interaction between dietary vitamin K intake and changes in INR with the VKAs...
March 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/26921085/drug-interactions-with-aprepitant-or-fosaprepitant-review-of-literature-and-implications-for-clinical-practice
#17
Anna Dushenkov, Julie Kalabalik, Antonia Carbone, Paiboon Jungsuwadee
PURPOSE: Aprepitant and its parenteral formulation fosaprepitant are widely used for the prevention of chemotherapy-induced nausea and vomiting. Aprepitant exerts modest inhibitory effect on CYP3A4 and modest inductive effect on CYP2C9 substrates such as some antineoplastics and multiple other medications. This article is aimed to provide pharmacists and other healthcare professionals with an updated summary of drug-drug interactions of aprepitant/fosaprepitant and implications for clinical practice...
February 25, 2016: Journal of Oncology Pharmacy Practice
https://www.readbyqxmd.com/read/26903765/patient-adherence-to-warfarin-therapy-and-its-impact-on-anticoagulation-control
#18
Ahmed Y Mayet
Warfarin is a commonly prescribed oral anticoagulant in Saudi Arabia and yet patient adherence to warfarin therapy and its impact on anticoagulation control have not been well researched here. A cross-sectional survey was conducted over 6 weeks at the outpatient anticoagulant clinic on patients who were receiving warfarin. Adherence was assessed using the translated Arabic version of the Morisky Medication Adherence Scale (MMAS-8). Levels of adherence were classed as low (score ⩽ 7), or high (score = 8) based on the scores...
January 2016: Saudi Pharmaceutical Journal: SPJ: the Official Publication of the Saudi Pharmaceutical Society
https://www.readbyqxmd.com/read/26855650/factors-affecting-the-quality-of-anticoagulation-with-warfarin-experience-of-one-cardiac-centre
#19
Tomasz Ciurus, Anna Cichocka-Radwan, Małgorzata Lelonek
INTRODUCTION: The risk of complications in anticoagulation therapy can be reduced by maximising the percentage of time spent by the patient in the optimal therapeutic range (TTR). However, little is known about the predictors of anticoagulation control. The aim of this paper was to assess the quality of anticoagulant therapy in patients on warfarin and to identify the factors affecting its deterioration. MATERIAL AND METHODS: We studied 149 patients who required anticoagulant therapy with warfarin due to non-valvular atrial fibrillation and/or venous thromboembolism...
December 2015: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/26679965/prevalence-of-low-cost-generic-program-use-in-a-nationally-representative-cohort-of-privately-insured-adults
#20
COMPARATIVE STUDY
Nathan James Pauly, Joshua David Brown
BACKGROUND: Administrative claims data are used for a wide variety of research and quality assurance purposes. Despite their utility, they are prone to medication exposure misclassification if medications are purchased without utilizing an insurance benefit. Low-cost generic programs (LCGPs) offered at major chain pharmacies are a relatively new and sparsely investigated source of exposure misclassification. Since they were implemented in 2006, LCGPs are now available at 8 of the 10 largest pharmacy chains and include a wide variety of medication classes...
December 2015: Journal of Managed Care & Specialty Pharmacy
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