scholarly journals Should patients manage their own oral anticoagulation therapy?

2002 ◽  
Vol 12 (4) ◽  
pp. 275-281 ◽  
Author(s):  
M Marzonlini ◽  
Hilary Wynne
Keyword(s):  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Anticoagulation Therapy ◽  
Therapeutic Index ◽  
Dose Requirement ◽  
Narrow Therapeutic Index ◽  
Thromboembolic Prophylaxis ◽  
Oral Anticoagulation Therapy ◽  
The Uk

Oral anticoagulant therapy has become more commonly prescribed for people of 65 years and over following the widening of its clinical indications to include thromboembolic prophylaxis in atrial fibrillation. It is estimated that approximately 470 000 people in the UK, almost 1% of the population, are currently receiving oral anticoagulant therapy and this is growing. Due to its narrow therapeutic index, and the intra-individual variation in dose requirement, there is a need to monitor the level of anticoagulation in each patient. In consequence, health systems have had to invest resources into monitoring services to cope with this development.

scholarly journals Educational protocol for patients on oral anticoagulant therapy: construction and validation

2014 ◽  
Vol 23 (3) ◽  
pp. 799-806 ◽  
Author(s):  
Flávia Martinelli Pelegrino ◽  
Fabiana Bolela ◽  
Inaiara Scalçone de Almeida Corbi ◽  
Ariana Rodrigues da Silva Carvalho ◽  
Rosana Aparecida Spadoti Dantas
Keyword(s):  
Literature Review ◽  
Oral Anticoagulant ◽  
Social Cognitive ◽  
Cognitive Theory ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Oral Anticoagulation Therapy ◽  
Final Version ◽  
The Face

This is a report of experience on the construction and validation of an educational protocol for patients on oral anticoagulation therapy. Based on Bandura's Social Cognitive Theory, three phases were identified to construct the educational protocol. The literature review on oral anticoagulants was used to prepare the content of each phase of the protocol. As a result, verbal and written orientation in the phases of attention and retention were developed. In the reproduction and motivation phase, support through contact by telephone was provided. And finally, an improvement in the evaluation of the outcomes related to oral anticoagulant is expected in the performance phase. Once the educational protocol was defined, we proceeded with the face and content validity process, which allowed adaptations to the final version of the educational protocol constructed.

Rebound Phenomenon After Discontinuation Of Oral Anticoagulant Therapy?

1981 ◽  
Author(s):  
J Harenberg ◽  
R Haas ◽  
R Zimmermann
Keyword(s):  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
In Vitro Release ◽  
Oral Anticoagulant Treatment ◽  
Thrombin Activity ◽  
Rebound Phenomenon

Duration and discontinuation of oral anticoagulant therapy in the prophylaxis of recurrent thrombembolic diseases is often discussed. After stopping of the therapy an elevated incidence of rethromboses are observed. Therefore we determined fibrinopeptide A (FPA) as the most sensitive parameter of thrombin activity in vivo in patients treated with phenprocoumon in order to get information on the effectivity of the oral anticoagulant therapy and on the rebound phenomenon after discontinuation of the treatment.In 136 outpatients a significant relation between FPA and the effectivity of the anticoagulant therapy was observed: 2.7 ng/ml plasma (mean, thrombotest values < 5%), 3.5 ng/ml (5%-15%) and 4.1 ng/ml (>15%, p < 0.01). Normal FPA were 1.4ng/ml. In 11 patients with low FPA the oral anticoagulants were discontinued. FPA was determined in weekly intervalls. Within four weeks a continous increase of FPA from 1.6 ng/ml (median) to 3.8 ng/ml was observed. After eight weeks FPA was 8.2 ng/ ml (p < 0.05). The in vitro release of FPA after 10 min incubation of blood increased from 3.4ng/ml to 72 ng/ml after eight weeks (p < 0.05, normal release up to 5 ng/ml).The data indicate the clinical relevance and the different therapeutic implications of the determination of FPA in patients treated with phenprocoumon. They further give the first criterion, which outlines the effectivity of an oral anticoagulation therapy by reducing the thrombin activity in vivo. They give some evidence for a rebound like phenomenon after discontinuation of the oral anticoagulant treatment.

scholarly journals Are Patients on Oral Anticoagulation Therapy Aware of its Effects? A Cross-sectional Study from Karachi, Pakistan

2020 ◽  
Author(s):  
Ibrahim Zahid ◽  
Syed Wajih Ul Hassan ◽  
Nida Sehar Bhurya ◽  
Sheena Nadeem Alam ◽  
Bakht Hussain Shah ◽  
...  
Keyword(s):  
Side Effects ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Herbal Medicines ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Life Threatening

Abstract Objective: Oral anticoagulants are one of the most frequently used medications. However, these drugs have a range of side effects including potential life-threatening complications. Little is known regarding the awareness of its side effect profile amongst the patients in Pakistan. Therefore, the aim of this study was to assess the knowledge of oral anticoagulant therapy and its side effects among its users. Results: The mean age was 48.9 ± 15.2 years. Mean scores of the participants for knowledge regarding oral anticoagulants and knowledge specific to warfarin were 49.9 ± 16.2% and 14.6 ± 16.4% respectively. Most notably, the majority of the patients (65.7%) did not know what side effects to be wary of or how to reduce their occurrence; and most of them were unaware of the interaction between oral anticoagulant drugs and over-the-counter substances such as aspirin, herbal medicines and alcohol. Knowledge of International Normalised Ratio (INR) was extremely poor with more than 75% of the population not being aware of the target INR range during warfarin therapy. Higher level of education was significantly associated with better knowledge scores. On the whole, knowledge of oral anticoagulant therapy and INR monitoring is extremely poor among oral anticoagulant users.

The Sensitivity and Specificity of Commercial Reagents for the Detection of Lupus Anticoagulant Show Marked Differences in Performance between Photo-optical and Mechanical Coagulometers

1999 ◽  
Vol 81 (05) ◽  
pp. 758-762 ◽  
Author(s):  
I. J. Mackie ◽  
G. Purdy ◽  
S. J. Machin ◽  
A. S. Lawrie
Keyword(s):  
Unfractionated Heparin ◽  
Sensitivity And Specificity ◽  
Anticoagulant Therapy ◽  
Lupus Anticoagulant ◽  
Oral Anticoagulant ◽  
Healthy Subjects ◽  
Oral Anticoagulant Therapy ◽  
Heparin Therapy ◽  
Optimal Performance ◽  
The Uk

SummaryThis study was undertaken to appraise the application of those reagents most widely used in the UK for the detection and confirmation of lupus anticoagulant (LA) on an Amelung KC4A and a Sysmex CA-6000™ coagulometer. Five sets of dilute Russell’s viper venom time (DRVVT) reagents were assessed as well as the Textarin®-PL/ Ecarin ratio. Each DRVVT method comprised both LA detection and confirmation reagents provided by the same manufacturer. Samples were obtained from 20 normal healthy subjects, 10 LA-positive patients, 10 patients receiving oral anticoagulant therapy (OAT) who had previously been documented as LA-positive, a further 10 LA-negative patients receiving OAT and 10 LA-negative patients receiving unfractionated heparin therapy. The sensitivity and specificity of the reagents exhibited considerable variation not only between reagents, but also when the same reagent was used on the two analysers. Sensitivity ranged from 62 to 97% (all reagents both analysers), specificity went as low as 23% (Gradipore reagent on the CA-6000™) and as high as 100% (American Diagnostica Inc on both KC4A and CA-6000™). On the KC4A instrument, Unicorn Diagnostics’ lupus anticoagulant kit offered the best compromise of sensitivity and specificity (sensitivity 83% and specificity 81%). On the CA-6000™ the reagents supplied by American Diagnostica Inc exhibited optimal performance (sensitivity 90% and specificity 100%). The results indicate a need to optimise test reagents for specific analyser types, a procedure which can only be undertaken with preparations such as the proposed NIBSC reference plasmas for the detection of lupus anticoagulant.

scholarly journals Are Patients on Oral Anticoagulation Therapy Aware of its Effects? A Cross-sectional Study from Karachi, Pakistan

2020 ◽  
Author(s):  
Ibrahim Zahid ◽  
Syed Wajih Ul Hassan ◽  
Nida Sehar Bhurya ◽  
Sheena Nadeem Alam ◽  
Bakht Hussain Shah ◽  
...  
Keyword(s):  
Side Effects ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Herbal Medicines ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Life Threatening

Abstract Objective: Oral anticoagulants are one of the most frequently used medications. However, these drugs have a range of side effects including potential life-threatening complications. Little is known regarding the awareness of its side effect profile amongst the patients in Pakistan. Therefore, the aim of this study was to assess the knowledge of oral anticoagulant therapy and its side effects among its users. Results: The mean age was 48.9± 15.2 years. Median scores of the participants for knowledge regarding oral anticoagulants and warfarin were 48.7 (8.3-91.7) and 10.3 (0.0-70.0) respectively. Of 207 patients, most notably, 65.7% did not know what side effects to be wary of or how to reduce their occurrence; and most patients were unaware of the interaction between oral anticoagulant drugs and over-the-counter substances such as aspirin, herbal medicines and alcohol. Knowledge of International Normalised Ratio (INR) was extremely poor with more than 75% of the population not being aware of the target INR range during warfarin therapy. Higher level of education was significantly associated with better knowledge scores. Overall, knowledge of oral anticoagulant therapy and INR monitoring is extremely poor among oral anticoagulant users.

scholarly journals Spontaneous rupture and hematoma of the sartorius muscle secondary to rivaroxaban therapy

2020 ◽  
Vol 2020 (4) ◽  
Author(s):  
Javier Ardebol ◽  
Mario Cahueque ◽  
Carlos Sanchez
Keyword(s):  
Anticoagulant Therapy ◽  
Spontaneous Rupture ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Sartorius Muscle ◽  
Factor X ◽  
Intracranial Hematomas

Abstract Spontaneous muscular hematomas are quite rare as they occur mush less frequently than intracranial hematomas and gastrointestinal bleeding in patients under oral anticoagulant therapy. Coumarins, such as warfarin or acitrom, are the most widely prescribed oral anticoagulants agents and have been associated more with the development of hematomas than direct factor X inhibitors, such as rivaroxaban [ 1]. Few reports have linked oral anticoagulation therapy with the development of muscular hematomas; however, clinical cases regarding the involvement of the sartorius muscle remain limited. Patients with advanced age, under oral anticoagulant therapy with pain and ecchymosis in the thigh region, should undergo radiological evaluation utilizing ultrasonography, computed tomography or magnetic resonance imaging to establish an accurate diagnosis. The following case consists of a patient that while resting presented with a spontaneous rupture and hematoma of the sartorius muscle secondary to rivaroxaban use. During follow-up, the patient recovered completely.

RESPONSE OF PROTEIN C AND PROTEIN S INHIBITORS IN LONG-TERM ORAL ANTICOAGULANT THERAPY

1987 ◽  
Author(s):  
M Mukhlova Montiel ◽  
H Bussey
Keyword(s):  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Protein C ◽  
Oral Anticoagulant Therapy ◽  
Anticoagulation Therapy ◽  
Protein S ◽  
Factor Vii ◽  
Control Group ◽  
Statistical Regression

Protein C (PC) and its coenzyme Protein S (PS) are physiologic inhibitors of activated factors Va and Villa. Deficiency of either one of these inhibitors has been associated with venous thrombosis. Their activity is dependent on vitamin K for hepatic gamma carboxylation and it is depressed during oral anticoagulant therapy. Because rebound thrombosis complicates cessation of anticoagulant therapy, we investigated the response of PC and PS during long term oral anti coagulation. The study encompassed 30 patients ranging between 26 and 76 years of age, who have received therapeutic doses of coumadin from 15 days to more than 8 years. The conditions for which treatment was initiated were deep vein thrombosis, cerebral vascular accidents and cardiac valve replacements.Factor VII and X activity was assayed by one step routine clotting assays. PC antigen (ag), total PSag and free PSag were assayed by Laurel 1 Rocket electroimmunodiffusion method. The measurement of the free PS was carried out after precipitation of C4b-binding protein with polyethylene glycol. PC activity was measured by clotting assay using PC deficient plasma to which was added patient plasma as a source of PC. Control group of 30 individuals in similar age group were assayed parallel with the patient samples. Compared with the control group the coumadin-treated patients showed substantial decrease of all factors studied. Statistical regression analysis of the coumadin group showed a significant increase in PS free (p = 0.014)during long term anti coagulation, while all of the other variables did not change significantly.PCag and total PSag were decreased and their activities, as expected, were more severely affected. The ratio of PC activity to PCag averages 0.39 (normal >0.80) and free PS represented only 27% of the total PSag (normal about 40%). The inhibitors' persistent activity parallels that of the depression of Factors VII and X and there appears to be a balanced coagulation-inhibi-tion system. If PC and PS play a role in rebound thrombosis after a prolonged anticoagulation therapy, the changes may occur after discontinuation of medication.

Controlled Trial of the Sequential Use of Streptokinase and Ancrod in the Treatment of Deep Vein Thrombosis of Lower Limb

1977 ◽  
Vol 37 (02) ◽  
pp. 222-232 ◽  
Author(s):  
D. A Tibbutt ◽  
C. N Chesterman ◽  
E. W Williams ◽  
T Faulkner ◽  
A. A Sharp
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Improvement ◽  
Anticoagulant Therapy ◽  
Lower Limb ◽  
Oral Anticoagulant ◽  
Controlled Trial ◽  
Oral Anticoagulant Therapy ◽  
Control Group ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryTreatment with streptokinase (‘Kabikinase’) was given to 26 patients with venographically confirmed deep vein thrombosis extending into the popliteal vein or above. Treatment was continued for 4 days and the patients were allocated randomly to oral anticoagulant therapy or a course of treatment with ancrod (‘Arvin’) for 6 days followed by oral anticoagulant therapy. The degree of thrombolysis as judged by further venographic examination at 10 days was not significantly different between the 2 groups. The majority of patients showed clinical improvement but there was no appreciable difference between the groups at 3 and 6 months. Haemorrhagic complications were a more serious problem during the period of treatment with ancrod than during the equivalent period in the control group.

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