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warfarin information race or culture or ethnic

Jessica D Nicholson, Yaman Kaakeh
PURPOSE: Current guidelines and research pertaining to pharmacotherapy considerations for management of patients with left ventricular assist devices (LVADs) are reviewed. SUMMARY: LVADs are being used more frequently to sustain patients with end-stage heart failure who are on a waitlist or ineligible for heart transplantation. The devices significantly impact patient physiology leading to unique medical complications and pharmacotherapy considerations. Pharmacists can play a vital role in understanding and relaying relevant medication concerns to the interdisciplinary healthcare team...
June 1, 2018: American Journal of Health-system Pharmacy: AJHP
Nijole Bernaitis, Chi Keong Ching, Siew Chong Teo, Tony Badrick, Andrew K Davey, Julia Crilly, Shailendra Anoopkumar-Dukie
BACKGROUND: Warfarin requires ongoing monitoring of the International Normalised Ratio (INR). This is because numerous factors influence the response, including drug interactions with commonly-prescribed medications, such as statins. The administration of statins with warfarin may change INR; however, there is limited information regarding the effects on warfarin control as measured by time in therapeutic range (TTR). Statins may also alter bleeds with warfarin, but there are conflicting reports demonstrating both increased and decreased bleeds, and limited data on diverse ethnic populations...
May 1, 2018: Journal of Clinical Medicine
Rashmi R Shah, Andrea Gaedigk
Inter-ethnic differences in drug response are all too well known. These are underpinned by a number of factors, including pharmacogenetic differences across various ethnic populations. Precision medicine relies on genotype-based prescribing decisions with the aim of maximizing efficacy and mitigating the risks. When there is no access to genotyping tests, ethnicity is frequently regarded as a proxy of the patient's probable genotype on the basis of overall population-based frequency of genetic variations in the ethnic group the patient belongs to, with some variations being ethnicity-specific...
January 2018: Therapeutic Advances in Drug Safety
Antony Martin, Jennifer Downing, Michelle Maden, Nigel Fleeman, Ana Alfirevic, Alan Haycox, Munir Pirmohamed
This review assessed evidence of disparities in benefits of pharmacogenomics related to 'model performance' in subgroups of patients and studies which reported impact on health inequalities. 'Model performance' refers to the ability of algorithms including clinical, environmental and genetic information to guide treatment. A total of 4978 abstracts were screened by one reviewer and 30% (1494) were double screened by a second independent reviewer, after which data extraction was performed. Additional forward and backward citation searching of reference lists was conducted...
November 2017: Pharmacogenomics
Raymond B Fohtung, Eric Novak, Michael W Rich
OBJECTIVES: To determine the effect of new oral anticoagulants (NOACs) on prescribing practices in older adults with atrial fibrillation (AF). DESIGN: Retrospective observational cohort study. SETTING: Academic medical center in St. Louis, Missouri. PARTICIPANTS: Individuals aged 75 and older with AF admitted to the hospital from October 2010 through September 2015 (N = 6,568, 50% female, 15% non-white). MEASUREMENTS: Information on NOACs and warfarin prescribed at discharge was obtained from hospital discharge summaries, and linear regression was used to examine quarterly trends in their use...
November 2017: Journal of the American Geriatrics Society
Ali Shafiq, Kensey Gosch, Amit P Amin, Henry H Ting, John A Spertus, Adam C Salisbury
Drug-eluting stents (DES) reduce risk of in-stent restenosis after percutaneous coronary intervention (PCI) but require dual antiplatelet therapy (DAPT) for a longer term than bare-metal stents (BMS). Few studies have examined clinical predictors of DES vs BMS, and variability in provider selection between DES and BMS in clinical practice has not been well described. These insights can inform our understanding of current practice and may identify opportunities to improve decision-making stent selection decinsion-making...
August 2017: Clinical Cardiology
Kathleen A Culhane-Pera, Robert J Straka, MaiKia Moua, Youssef Roman, Pachia Vue, Kang Xiaaj, May Xia Lo, Mai Lor
Advancing precision medicine relies in part on examining populations that may exhibit unique genetic variants that impact clinical outcomes. Failure to include diverse populations in genomic-based research represents a health disparity. We implemented a community-based participatory research (CBPR) process with the Hmong community in Minnesota, who were refugees from Laos, in order to assess the feasibility of conducting genomic and pharmacogenomic-based research for genetic variants that are relevant to the Hmong community...
April 2017: Journal of Community Genetics
Jennifer Y Lo, L LuAnn Minich, Lloyd Y Tani, Jacob Wilkes, Qian Ding, Shaji C Menon
Management guidelines for refractory Kawasaki disease (KD) are vague. We sought to assess practice variation and identify factors associated with large/complex coronary artery aneurysms (LCAA) and resource utilization in refractory KD. This retrospective cohort study identified patients aged ≤18 years with KD (2004 to 2014) using the Pediatric Health Information System. Refractory KD was defined as receiving >1 dose of intravenous immunoglobulin. Demographics, medications, concomitant infections, length of stay (LOS), and charges were collected...
December 1, 2016: American Journal of Cardiology
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
Sagar U Nigwekar, Sophia Zhao, Julia Wenger, Jeffrey L Hymes, Franklin W Maddux, Ravi I Thadhani, Kevin E Chan
Accurate identification of risk factors for calcific uremic arteriolopathy (CUA) is necessary to develop preventive strategies for this morbid disease. We investigated whether baseline factors recorded at hemodialysis initiation would identify patients at risk for future CUA in a matched case-control study using data from a large dialysis organization. Hemodialysis patients with newly diagnosed CUA (n=1030) between January 1, 2010, and December 31, 2014, were matched by age, sex, and race in a 1:2 ratio to hemodialysis patients without CUA (n=2060)...
November 2016: Journal of the American Society of Nephrology: JASN
G Y H Lip, T Potpara, G Boriani, C Blomström-Lundqvist
The main priority in atrial fibrillation (AF) management is stroke prevention, following which decisions about rate or rhythm control are focused on the patient, being primarily for management of symptoms. Given that AF is commonly associated with various comorbidities, risk factors such as hypertension, heart failure, diabetes mellitus and sleep apnoea should be actively looked for and managed in a holistic approach to AF management. The objective of this review is to provide an overview of modern AF stroke prevention with a focus on tailored treatment strategies...
May 2016: Journal of Internal Medicine
Harsh Golwala, Larry R Jackson, DaJuanicia N Simon, Jonathan P Piccini, Bernard Gersh, Alan S Go, Elaine M Hylek, Peter R Kowey, Kenneth W Mahaffey, Laine Thomas, Gregg C Fonarow, Eric D Peterson, Kevin L Thomas
BACKGROUND: Significant racial/ethnic differences exist in the incidence of atrial fibrillation (AF). However, less is known about racial/ethnic differences in quality of life (QoL), treatment, and outcomes associated with AF. METHODS: Using data from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, we compared clinical characteristics, QoL, management strategies, and long-term outcomes associated with AF among various racial/ethnic groups...
April 2016: American Heart Journal
Sarayu Arvind Pai, Nilima Kshirsagar
Our objective was to compare the pharmacogenetic information provided in the package inserts (PIs) of 7 drugs marketed in the United States and India, namely, abacavir, capecitabine, carbamazepine, clopidogrel, irinotecan, valproic acid, and warfarin. We evaluated the pharmacogenetic information provided in Indian PIs for the highest level where it was included, robustness and completeness, clinical validity, and clinical utility and compared it with corresponding data of US PIs. Pharmacogenetic studies carried out in India were identified using PubMed...
October 2016: Journal of Clinical Pharmacology
Tomoko S Kato, Marco R Di Tullio, Min Qian, Mengfei Wu, John L P Thompson, Douglas L Mann, Ralph L Sacco, Patrick M Pullicino, Ronald S Freudenberger, John R Teerlink, Susan Graham, Gregory Y H Lip, Bruce Levin, Jay P Mohr, Arthur J Labovitz, Conrado J Estol, Dirk J Lok, Piotr Ponikowski, Stefan D Anker, Shunichi Homma
BACKGROUND: Heart failure (HF) patients have a high incidence of new-onset AF. Given the adverse prognostic influence of AF in HF, identifying patients at high risk of developing AF is important. METHODS AND RESULTS: The incidence and factors associated with new-onset AF were investigated in patients in sinus rhythm with reduced LVEF enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial. Analyses involved clinical factors alone (n=2,219), and clinical plus echocardiographic findings (n=1,125)...
2016: Circulation Journal: Official Journal of the Japanese Circulation Society
Ricardo Ventura Santos, Gláucia Oliveira da Silva, Sahra Gibbon
Public funding for research on the action of drugs in countries like the United States requires that racial classification of research subjects should be considered when defining the composition of the samples as well as in data analysis, sometimes resulting in interpretations that Whites and Blacks differ in their pharmacogenetic profiles. In Brazil, pharmacogenomic results have led to very different interpretations when compared with those obtained in the United States. This is explained as deriving from the genomic heterogeneity of the Brazilian population...
March 1, 2015: BioSocieties
Olakunle Akinboboye
Atrial fibrillation (AF) is a very common cardiac arrhythmia, and its prevalence is increasing along with aging in the developed world. This review discusses racial differences in the epidemiology and treatment of AF between African-American and Caucasian patients. Additionally, the effect of race on warfarin and novel oral anticoagulant use is discussed, as well as the role that physicians and patients play in achieving optimal treatment outcomes. Despite having a lower prevalence of AF compared with Caucasians, African-Americans suffer disproportionately from stroke and its sequelae...
2015: Journal of Multidisciplinary Healthcare
Louis Moyer
Miscellaneous Cases ISESSION TYPE: Affiliate Case Report SlidePRESENTED ON: Sunday, October 26, 2014 at 10:45 AM - 12:00 PMINTRODUCTION: Atrioesophageal fistula (AEF) is a life-threatening complication of left atrial ablation for atrial fibrillation. AEF resulting in embolic stroke is rare and difficult to recognize, but prompt diagnosis may increase options for repair and survival.CASE PRESENTATION: A 70-year-old female with a PMH significant for atrial fibrillation on warfarin underwent two left atrial ablations within 10 days...
October 1, 2014: Chest
Sayeed Nasser, Judy Mullan, Beata Bajorek
OBJECTIVE: To explore healthcare professionals' views about the benefits and challenges of using information technology (IT) resources for educating patients about their warfarin therapy. METHODS: A cross-sectional survey of both community and hospital-based healthcare professionals (e.g., doctors, pharmacists and nurses) involved using a purpose-designed questionnaire. The questionnaires were distributed using a multi-modal approach to maximise response rates. RESULTS: Of the total 300 questionnaires distributed, 109 completed surveys were received (43...
April 2012: Pharmacy Practice
K E Liu, C-L Lo, Y-H Hu
OBJECTIVES: Due to the narrow therapeutic range and high drug-to-drug interactions (DDIs), improving the adequate use of warfarin for the elderly is crucial in clinical practice. This study examines whether the effectiveness of using warfarin among elderly inpatients can be improved when machine learning techniques and data from the laboratory information system are incorporated. METHODS: Having employed 288 validated clinical cases in the DDI group and 89 cases in the non-DDI group, we evaluate the prediction performance of seven classification techniques, with and without an Adaptive Boosting (AdaBoost) algorithm...
2014: Methods of Information in Medicine
Brady S Moffett, Shelly Kim, Lisa R Bomgaars
BACKGROUND: Warfarin therapy in pediatric patients can be difficult to manage with bleeding as a primary adverse event. Therapy initiation can be difficult as doses to achieve therapeutic outcomes are being determined. Evaluation of readmission for bleeding in pediatric patients discharged on warfarin therapy may be useful to prevent adverse events. METHODS: The Pediatric Health Information System (PHIS) was queried to identify all patients <19 years of age who were discharged from a pediatric hospital on warfarin therapy...
September 2013: Pediatric Blood & Cancer
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