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

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.

Download Full-text

Adaptation and validation of an oral anticoagulation measurement of treatment adherence instrument

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692010000300002 ◽

2010 ◽

Vol 18 (3) ◽

pp. 301-308 ◽

Cited By ~ 7

Author(s):

Ariana Rodrigues da Silva Carvalho ◽

Rosana Aparecida Spadoti Dantas ◽

Flávia Martinelli Pelegrino ◽

Inaiara Scalçone Almeida Corbi

Keyword(s):

Mental Health ◽

Treatment Adherence ◽

Oral Anticoagulation ◽

Oral Anticoagulant Therapy ◽

Anticoagulation Therapy ◽

Methodological Study ◽

Oral Anticoagulation Therapy ◽

Final Version ◽

Weak Evidence ◽

Sf 36

This methodological study adapted and analyzed the psychometric properties of the Measurement of Treatment Adherence (MTA) instrument for Brazilian users of oral anticoagulation therapy. Its final version was tested with 178 individuals. The average of answers for all questions ranged from 4.6 to 5.8 and 97.2% of the individuals were considered adherent. Moderate correlations were obtained between the adherence measure and the Mental health and Vitality domains of the SF-36. Cronbach’s alpha was 0.60 and the ceiling effect occurred in answers to all items. These results indicate weak evidence of the validity, reliability and responsiveness of the MTA-adapted version for users of oral anticoagulant therapy.

Download Full-text

Rebound Phenomenon After Discontinuation Of Oral Anticoagulant Therapy?

10.1055/s-0038-1653092 ◽

1981 ◽

Cited By ~ 1

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.

Download Full-text

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

10.21203/rs.3.rs-20667/v1 ◽

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.

Download Full-text

Should patients manage their own oral anticoagulation therapy?

Reviews in Clinical Gerontology ◽

10.1017/s0959259802012418 ◽

2002 ◽

Vol 12 (4) ◽

pp. 275-281 ◽

Cited By ~ 6

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.

Download Full-text

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

10.21203/rs.3.rs-20667/v2 ◽

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.

Download Full-text

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

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa090 ◽

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.

Download Full-text

Determination of the International Sensitivity Index of a New Near-Patient Testing Device to Monitor Oral Anticoagulant Therapy

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657641 ◽

1997 ◽

Vol 78 (02) ◽

pp. 855-858 ◽

Cited By ~ 25

Author(s):

Armando Tripodi ◽

Veena Chantarangkul ◽

Marigrazia Clerici ◽

Barbara Negri ◽

Pier Mannuccio Mannucci

Keyword(s):

Linear Relationship ◽

Whole Blood ◽

Oral Anticoagulant ◽

Oral Anticoagulant Therapy ◽

Oral Anticoagulants ◽

Calibration Model ◽

Testing Device ◽

Data Points ◽

Near Patient Testing

SummaryA key issue for the reliable use of new devices for the laboratory control of oral anticoagulant therapy with the INR is their conformity to the calibration model. In the past, their adequacy has mostly been assessed empirically without reference to the calibration model and the use of International Reference Preparations (IRP) for thromboplastin. In this study we reviewed the requirements to be fulfilled and applied them to the calibration of a new near-patient testing device (TAS, Cardiovascular Diagnostics) which uses thromboplastin-containing test cards for determination of the INR. On each of 10 working days citrat- ed whole blood and plasma samples were obtained from 2 healthy subjects and 6 patients on oral anticoagulants. PT testing on whole blood and plasma was done with the TAS and parallel testing for plasma by the manual technique with the IRP CRM 149S. Conformity to the calibration model was judged satisfactory if the following requirements were met: (i) there was a linear relationship between paired log-PTs (TAS vs CRM 149S); (ii) the regression line drawn through patients data points, passed through those of normals; (iii) the precision of the calibration expressed as the CV of the slope was <3%. A good linear relationship was observed for calibration plots for plasma and whole blood (r = 0.98). Regression lines drawn through patients data points, passed through those of normals. The CVs of the slope were in both cases 2.2% and the ISIs were 0.965 and 1.000 for whole blood and plasma. In conclusion, our study shows that near-patient testing devices can be considered reliable tools to measure INR in patients on oral anticoagulants and provides guidelines for their evaluation.

Download Full-text

Management of Oral Anticoagulation Therapy After Gastrointestinal Bleeding: Whether to, When to, and How to Restart an Anticoagulation Therapy

Annals of Pharmacotherapy ◽

10.1177/1060028017717019 ◽

2017 ◽

Vol 51 (11) ◽

pp. 1000-1007 ◽

Cited By ~ 9

Author(s):

Kazuhiko Kido ◽

Michael J. Scalese

Keyword(s):

Gastrointestinal Bleeding ◽

Cohort Studies ◽

Oral Anticoagulation ◽

Retrospective Cohort ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Cochrane Library ◽

Oral Anticoagulation Therapy ◽

Retrospective Cohort Studies

Objective: To evaluate current clinical evidence for management of oral anticoagulation therapy after gastrointestinal bleeding (GIB) with an emphasis on whether to, when to, and how to resume an anticoagulation therapy. Data Sources: Relevant articles from MEDLINE, Cochrane Library, and EMBASE databases were identified from 1946 through May 20, 2017, using the keywords: gastrointestinal hemorrhage or gastrointestinal bleeding and antithrombotic therapy or anticoagulation therapy or warfarin or dabigatran or rivaroxaban or apixaban or edoxaban.Study Selection and Data Extraction: All English-language studies assessing management of oral anticoagulation therapy after GIB were evaluated. Data Synthesis: A total of 9 studies were identified. Four retrospective cohort studies showed that resuming anticoagulation therapy was associated with significantly lower rate of thromboembolism (TE) in the general population. Meta-analyses and prospective cohort studies also supported this finding. Two retrospective cohort studies indicated an increase in GIB when anticoagulation reinitiation occurred in less than 7 days without a decrease in TE. Resuming therapy between 7 and 15 days did not demonstrate a significant increase in GIB or TE. A large retrospective study showed that apixaban was associated with the significantly lowest risk of GIB compared with both rivaroxaban and dabigatran. Conclusion: Anticoagulation therapy resumption is recommended, with resumption being considered between 7 and 14 days following GIB regardless of the therapy chosen. Data for warfarin management after GIB should be applied with caution to direct oral anticoagulants (DOACs) because of the quicker onset and experimental nature of reversal agents. Apixaban may be a preferred option when restarting a DOAC therapy.

Download Full-text