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warfarin education elderly

Laressa Bethishou, Tania Gregorian, Kimberly Won, Kristina Lopez, Laura V Tsu
Objective To provide an up-to-date review of the available evidence regarding pharmacotherapeutic management of venous thromboembolic events in the geriatric population. Data Sources A PubMed search of articles published through August 2017 was performed using a combination of the following words: apixaban, betrixaban, dabigatran, edoxaban, enoxaparin, geriatric, heparin, idaricizumab, rivaroxaban, and venous thromboembolism. Study Selection/data Extraction Relevant original research, review articles, and guidelines were assessed for the management of elderly patients with venous thromboembolism (VTE)...
May 1, 2018: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
Beata Łabuz-Roszak, Michał Skrzypek, Agnieszka Machowska-Majchrzak, Małgorzata Mossakowska, Jerzy Chudek, Andrzej Więcek, Krystyna Pierzchała, Beata Łącka-Gaździk, Tomasz Grodzicki
INTRODUCTION: Atrial fibrillation (AF) is the most frequent clinically significant arrhythmia, especially common in the elderly. As it is known, AF is associated with increased risk of stroke. Little is known about pharmacological cardiovascular prevention in the elderly with AF in Poland. OBJECTIVES: The purpose of the study was to evaluate the frequency of pharmacological stroke prevention among the elderly with AF in Poland and its association with clinical characteristics and concomitant cardiovascular risk factors...
September 2017: Neurologia i Neurochirurgia Polska
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
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
Qinmei Xiong, Gregory Y H Lip
Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, which can potentially increases the risk of stroke by five-fold, thus, resulting in high public healthcare burden. Stroke prevention is vital in the management of AF patients. Vitamin K antagonists (VKA, eg, warfarin) have been the mainstay treatment to prevent ischemic stroke and systemic thromboembolism in AF patients for several decades. Despite the efficacy of warfarin, its limitations have recently driven the advent of some new antithrombotic agents, the non-VKA oral anticoagulant (NOACs, including dabigatran, rivaroxaban, apixaban, and edoxaban)...
February 2015: Current Treatment Options in Neurology
Shu-jie Dong, Ting Zhang, Yan Li, Suo-di Zhai
Warfarin is a high-alert medication, which may result in bleeding if used improperly. In our case, one elderly female with atrial fibrillation had taken warfarin for more than half a year, and her international normalized ratio (INR) was maintained within the therapeutic range. The patient began to take tramadol to alleviate her shoulder pain. Three days later she presented hematuresis and had ecchymosis in her right upper arm, and in the meantime her INR rose to 10.04. Clinical pharmacists analyzed the cause for bleeding by searching relevant literature, and finally discovered the interaction between warfarin and tramadol...
October 18, 2014: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Ning Cui, Hesheng Luo
OBJECTIVE: To explore the correlative factors and clinical characteristics of digestive system injury during the treatment of anticoagulant and (or) antiplatelet-agents. METHODS: A total of 1 443 hospitalized patients on anticoagulant and (or) antiplatelet-agents from January 2010 to December 2013 at Renmin Hospital of Wuhan University were analyzed retrospectively. RESULTS: Their length of hospital stay was from 5 to 27 days. Most of them were elderly males (n = 880, 61...
May 27, 2014: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Beata Bajorek
Anticoagulant drugs maintain a high potential for adverse events due to their inherent risk of haemorrhage and/or complex pharmacology. In addition, compromising the safety of these agents is the context in which they are principally used; that is, in the long-term prevention of thromboembolic diseases in an older patient population. These challenges are especially pronounced in the prevention of stroke in older persons with atrial fibrillation (AF), where the need for thromboprophylaxis is paramount and in whom the arrhythmia is most prevalent, but where the target population is simultaneously at high risk of adverse drug events...
April 2011: Therapeutic Advances in Drug Safety
Beata Labuz-Roszak, Michał Skrzypek, Krystyna Pierzchała, Agnieszka Machowska-Majchrzak, Małgorzata Mossakowska, Jerzy Chudek, Iwona Mańka-Gaca, Wojciech Bartman, Andrzej Więcek
BACKGROUND AND PURPOSE: The purpose of the study was to evaluate the frequency of use of oral antiplatelet (OAP) and anticoagulant (OAC) drugs as secondary stroke prevention among older people in Poland and its association with sociodemographic factors, place of residence, and concomitant cardiovascular risk factors. MATERIAL AND METHODS: The study group consisted of 426 subjects with a history of a previous stroke (mean age of 81.5±8.2 years), participants of multicentre, population-based PolSenior study...
2014: Neurologia i Neurochirurgia Polska
Stan W Darnell, Stephanie C Davis, John J Whitcomb, Joseph A Manfredi, Brent T McLaurin
PURPOSE: Inadequate anticoagulation among elderly individuals with atrial fibrillation (AF) is a common problem. This synthesis of the literature review describes the pathophysiology of AF, explains the mechanism of action of warfarin (Coumadin), identifies factors that contribute to warfarin (Coumadin)-associated bleeding in the elderly population, and explores alternatives to warfarin (Coumadin) therapy. Implications for advanced practice nurse practice, education, and research will be discussed...
March 2014: Dimensions of Critical Care Nursing: DCCN
Steven Deitelzweig
BACKGROUND: Thromboprophylaxis with oral anticoagulants is an important but underused element of atrial fibrillation (AF) treatment. Reduction of stroke risk by anticoagulants comes at the price of bleeding risk. Patients with AF receiving anticoagulants require heightened attention with transition from one care setting to another. METHODS: This review of the literature focuses on issues specific to the anticoagulation treatment of patients with AF. RESULTS: Patients presenting for emergency care of anticoagulant-related bleeding should be triaged for the severity and source of the bleeding using appropriate measures, such as discontinuing the oral anticoagulant, administering vitamin K when appropriate to reverse warfarin-induced bleeding, or administering clotting factors for emergent bleeding...
2013: Ochsner Journal
Ashley N Pugh, Bethany L Murphy
Although anticoagulation therapy with warfarin is necessary for many patients, the burden of frequent clinic visits for monitoring of therapy can pose a potential problem for some older adults. As self-monitoring of warfarin therapy has grown in popularity, a recent meta-analysis has reviewed data relating to self-testing and self-management of anticoagulation therapy. This same study also analyzed outcomes in the elderly, finding a potential benefit for self-monitoring in this population. This potential benefit, combined with the difficulties many elderly patients have attending clinic visits because of a lack of mobility or unavailability of transportation, makes self-monitoring of warfarin a viable option for carefully selected elderly patients...
May 2013: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
Steven B Deitelzweig
Thromboprophylaxis with oral anticoagulants (OACs) is an important but underused element of atrial fibrillation (AF) treatment. Reduction of stroke risk with anticoagulants comes at the price of increased bleeding risk. Patients with AF receiving anticoagulants require heightened attention with transition from one care setting to another. Patients presenting for emergency care of anticoagulant-related bleeding should be triaged for the severity and source of the bleeding using appropriate measures, such as discontinuing the OAC, administering vitamin K, when appropriate, to reverse warfarin-induced bleeding, or administering clotting factors for emergent bleeding...
October 2012: Hospital Practice (Minneapolis)
Sara Modig, Peter Höglund, Margareta Troein, Patrik Midlöv
BACKGROUND: Evidence-based guidelines should in most cases be followed also in the treatment of elderly. Older people are often suboptimally treated with the recommended drugs. OBJECTIVES: To describe how well general practitioners adhere to current guidelines in the treatment of elderly with cardiovascular disease and evaluate local education as a tool for improvement. METHOD: Data was collected from the medical records of patients aged ≥ 65, who visited a primary health care center in Sweden 2006 and had one or more of the following diagnoses: hypertension, ischemic heart disease, heart failure, chronic atrial fibrillation, or prior stroke...
2012: TheScientificWorldJournal
Eric Pautas, Jérémie Despres, Isabelle Peyron, Jean-Louis Golmard, Jennifer Grange, Nelly Koenig, Adeline Gouronnec, Nathalie Mitha, Virginie Siguret, Isabelle Gouin-Thibault
BACKGROUND: Vitamin K antagonist tablets are often split to fractionate the dose by elderly patients. We performed a study in order to assess the divisibility of one dosage strength of score-lined warfarin and of score-lined fluindione. METHODS: Due to a recent change in the pharmaceutical form of fluindione in order to improve the divisibility, the study was performed over 2 different periods (with the « old » and with the « new » pharmaceutical form). In each period, 10 patients mean aged 82 years, 10 relatives, 10 nurses, 10 medical doctors) were asked to split in half warfarin tablets (W2 1(st) period et W2 2(d) period) and fluindione tablets (F2 et F'2), and to split fluindione tablets into 4 fragments (F4 et F'4)...
June 2011: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
(no author information available yet)
One estimate suggests that at least 1 million people in the UK are on the anticoagulant warfarin.1 This number could increase as more people are treated with the drug for atrial fibrillation and as the elderly population increases.1 Careful control of anticoagulation is essential with warfarin therapy and, traditionally, patients on the drug have had to travel to a clinic to have their blood coagulation time tested. However, the availability of portable self-testing machines makes it possible for some patients to monitor their blood coagulation time at home...
September 2009: Drug and Therapeutics Bulletin
Candice L Garwood, Tia L Corbett
OBJECTIVE: To evaluate data addressing use of anticoagulation in elderly patients with atrial fibrillation (AF), in particular those at risk of falls. DATA SOURCES: Primary literature was identified through PubMed MEDLINE (1966-December 2007) and EMBASE (1980-December 2007) using the search terms anticoagulation, warfarin, aspirin, elderly, falls, older persons, atrial fibrillation, bleeding, education, stroke, and use. Additional references were obtained through review of references from articles obtained...
April 2008: Annals of Pharmacotherapy
Elizabeth M McClaskey, Elizabeth Landrum Michalets
The elderly population is at an increased risk for major bleeding, possibly due to increased sensitivity to anticoagulation, multiple comorbidities, and polypharmacy. Elderly patients receiving antiplatelet and anticoagulant therapy have an additional risk for bleeding. Omega-3 fatty acids, also known as fish oil, have been used for hyperlipidemia, coronary heart disease, hypertension, and other conditions. Some studies have demonstrated that consumption of fish oil concentrate, n-3 polyunsaturated fatty acid (n-3 PUFA), results in cardiovascular benefits that include reductions in mortality, sudden death, nonfatal myocardial infarction, and thrombotic stoke, as well as improvement in graft patency...
January 2007: Pharmacotherapy
Patrick W Sullivan, Thomas W Arant, Samuel L Ellis, Heather Ulrich
BACKGROUND: Anticoagulation therapy with warfarin is widely considered the standard of care for stoke prophylaxis in patients with atrial fibrillation who are at high risk of stroke. Community-based studies in the US have reported that the effectiveness of anticoagulation varies by management approach and that patients receiving warfarin have international normalised ratio (INR) values within the target therapeutic range less than half the time. OBJECTIVE: To estimate the lifetime societal costs and health benefits of warfarin therapy to prevent strokes, specifically in elderly patients (mean age 70 years) with atrial fibrillation who are at high risk of stroke, when anticoagulation is managed through usual care versus anticoagulation management services, where dedicated anticoagulation professionals (e...
2006: PharmacoEconomics
Kathleen M Haig, Staci Sutton, John Whittington
BACKGROUND: The importance of sharing a common mental model in communication prompted efforts to spread the use of the SBAR (Situation, Background, Assessment, and Recommendation) tool at OSF St. Joseph Medical Center, Bloomington, Illinois. CASE STUDY: An elderly patient was on warfarin sodium (Coumadin) 2.5 mg daily. The nurse received a call from the lab regarding an elevated international normalized ratio (INR) but did not write down the results (she was providing care to another patient)...
March 2006: Joint Commission Journal on Quality and Patient Safety
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