scholarly journals IMPACT OF PHARMACIST LED ANTICOAGULATION MONITORING AND PATIENT EDUCATION ON ORAL ANTICOAGULATION THERAPY WITH ACENOCOUMAROL

2017 ◽  
Vol 10 (10) ◽  
pp. 314
Author(s):  
Poojitha Reddy Reddy ◽  
Omsri Mounika ◽  
Gaddam Chandrika ◽  
Aldrich Franklin ◽  
Ramesh M ◽  
...  
Keyword(s):  
Patient Education ◽  
Drug Interactions ◽  
Oral Anticoagulation ◽  
Anticoagulation Therapy ◽  
Therapeutic Index ◽  
International Normalized Ratio ◽  
Rank Test ◽  
Oral Anticoagulation Therapy ◽  
Before And After ◽  
The Impact

  Objective: Acenocoumarol is anoral anticoagulant with narrow therapeutic index, and the ideal dose of anticoagulation lies between International normalized ratio (INR) values of 2.0 and 3.5. Lack of monitoring and knowledge on acenocoumarol therapy may compromise patient’s safety resulting in under- or over-anticoagulation. A study was conducted to monitor for the safety of anticoagulation therapy, achievement of goal INR levels and to assess the impact of pharmacist led anticoagulation monitoring and patient education on the rational use of acenocoumarol in patients admitted in cardiology wards with thromboembolic disorders.Methods: The study was conducted in 70 patients; data collection was done, prescriptions were analyzed for drug-drug interactions and adverse drug reactions (ADRs). Patients’ knowledge on acenocoumarol therapy was assessed using a self-developed questionnaire at the baseline, then were subjected to a detailed patient education and on an average each patient received three sessions of education. They were again made to answer the same questionnaire on the day of discharge. The mean score of the responses before and after education was compared statistically using Wilcoxon signed rank test and McNemar test.Results: There were 60% patients under anticoagulated with the INR range of >2.0. 123 drug interactions were observed in 58 patients, on an average of 2 interactions per prescription, but no ADRs were observed. 59 patients (84.3%) showed significant overall improvement in knowledge on anticoagulation therapy following education.Conclusion: This study implies the role of clinical pharmacists in achieving better clinical outcomes in patients receiving oral anticoagulation therapy with acenocoumarol.

scholarly journals A non-experimental study of oral anticoagulation therapy initiation before and after national patient safety goals

BMJ Open ◽  
2014 ◽  
Vol 4 (2) ◽  
pp. e003960 ◽  
Author(s):  
Christopher A Beadles ◽  
Kristen Hassmiller Lich ◽  
Anthony J Viera ◽  
Sandra B Greene ◽  
M Alan Brookhart ◽  
...  
Keyword(s):  
Experimental Study ◽  
Patient Safety ◽  
Oral Anticoagulation ◽  
Anticoagulation Therapy ◽  
Oral Anticoagulation Therapy ◽  
Therapy Initiation ◽  
Before And After ◽  
National Patient

Implementation of SintromacWeb®, a new internet-based tool for oral anticoagulation therapy telecontrol: Study on system consistency and patient satisfaction

2010 ◽  
Vol 103 (05) ◽  
pp. 1091-1101 ◽  
Author(s):  
Yolanda Mira ◽  
María Teresa Contreras ◽  
Cristina Aguado ◽  
José Antonio Aznar ◽  
Fernando Ferrando
Keyword(s):  
Patient Satisfaction ◽  
Oral Anticoagulation ◽  
Point Of Care ◽  
Anticoagulation Therapy ◽  
International Normalized Ratio ◽  
Final Visit ◽  
Normal Range ◽  
Oral Anticoagulation Therapy ◽  
Self Testing ◽  
Anticoagulated Patients

SummaryMost computer- or internet-assisted systems for oral anticoagulation therapy (OAT) telemanagement have limitations when it comes to implementation within a healthcare center. It was the objective of this study to evaluate convenience and patient satisfaction with the use of SintromacWeb→, a new OAT telecontrol system, compared with the conventional control. SintromacWeb® consists of a point-of-care device for patient international normalized ratio (INR) self-testing and software that allows internet mediated interaction with physicians. Patients initiated the use of SintromacWeb→ and were followed up during a three-month period. A score-based questionnaire was completed in three controlled visits, and data were subsequently analysed. A total of 102 patients were enrolled. At first visit, 55.7% of the patients had their INR within normal range, and 64.9% at the final visit. Internal consistency of the questionnaire was good (Cronbach‘s α: 0.79). Scores in the questionnaire were independent of patient’s age, education level, working status and INR value. The most valued features of SintromacWeb® were: fewer visits to the hospital, simplicity and convenience of the system, and time administration for control tasks (86.7%, 82.7% and 77.6% of very satisfied patients, respectively). Also, patients showed indifference or were dissatisfied with the conventional system. At the final visit, 99% of patients declared that they were satisfied with their OAT control. Moreover, all patients continued using Sintrom -acWeb→ after completion of the study. In conclusion, SintromacWeb→ telecontrol is a new model for management of anticoagulated patients. It was highly accepted and can be used by all patients regardless of their sociodemographic characteristics.

scholarly journals The Impact of Using Mobile Applications on Health Outcomes in Patient Self-Management of Oral Anticoagulation Therapy

2021 ◽  
Author(s):  
Hamid Moghaddasi ◽  
Mohammadreza Naderi Haji ◽  
Babak Sharif-Kashani ◽  
Alireza Kazemi
Keyword(s):  
Health Outcomes ◽  
Therapeutic Range ◽  
Oral Anticoagulation ◽  
Mobile Applications ◽  
Mobile Application ◽  
Anticoagulation Therapy ◽  
Self Management ◽  
Oral Anticoagulation Therapy ◽  
The Mean ◽  
The Impact

Abstract Background Between one and two percent of the population of the developed countries are currently treated with oral anticoagulation therapy. The transition of all or part of the responsibility for therapy management to the patient is an appropriate strategy to respond increasing demand for oral anticoagulation therapy. The main objective of this original study was to investigate the impact of using mobile applications on health outcomes in patient self-management of oral anticoagulation therapy. Methods The papers reviewed in this study had two key characteristics: firstly, they were written in English, and secondly, they used mobile application in oral anticoagulation therapy. An Android mobile application called XrinA was developed to provide warfarin patient self-management. The study was conducted following a Before-After study design. In the Before and After periods, patients were treated as usual and by using the developed application, respectively. Results In the Before period, the mean percentage of International Normalized Ratios (INRs) within the therapeutic range and Time in Therapeutic Range (TTR) of patients was 31.63% and 34.4%, respectively. In the After period, the mean percentage of INRs within the therapeutic range and TTR of patients was 41.41% and 49.97%, respectively. In the After period, the mean INRs within the therapeutic range and the mean TTR increased by 9.78% and 15.57%, respectively. Conclusions Overall, the use of mHealth applications improved outcomes in patient self-management of oral anticoagulation therapy in terms of the percentage of INRs within the therapeutic range and TTR.

scholarly journals Efficacy of Prothrombin Complex Concentrate Treatment in Patients with Liver Coagulopathy Who Underwent Various Invasive Hepatobiliary and Gastrointestinal Procedures

2016 ◽  
Vol 10 (2) ◽  
pp. 315-322 ◽  
Author(s):  
Cosmas Rinaldi A. Lesmana ◽  
Lidwina Cahyadinata ◽  
Levina S. Pakasi ◽  
Laurentius A. Lesmana
Keyword(s):  
Anticoagulation Therapy ◽  
Bleeding Event ◽  
International Normalized Ratio ◽  
Bleeding Complications ◽  
Rank Test ◽  
Upper Gastrointestinal Endoscopy ◽  
Invasive Procedures ◽  
Open Label ◽  
Before And After ◽  
Signed Rank Test

Background: Prothrombin complex concentrates (PCCs) containing prothrombin, factors VII, IX, and X, as well as the inhibitors protein C and S have been used as an emergent reversal for oral anticoagulation therapy. The use of PCCs in hepatobiliary disorder patients or patients with liver coagulopathy who need to undergo invasive procedures has not been well studied. Objective: To evaluate the efficacy of PCC treatment in order to control or prevent bleeding complications in patients with liver coagulopathy who undergo various invasive procedures. Methods: This was a prospective, open-label, non-randomized, before-and-after study in patients with hepatobiliary disorders who underwent invasive procedures accompanied by liver impairment and received PCC injection (Cofact®, Sanquin, The Netherlands). Patients with coagulopathy from various causes were recruited consecutively. Data collected were the episodes of bleeding, liver function test and the international normalized ratio (INR) before and after PCC therapy. The primary endpoint was INR change after treatment, while secondary endpoints included bleeding control and bleeding event after treatment. Results: Thirty patients (17 men, 13 women) were enrolled. Patients’ mean age was 57.0 + 15.5 years. Liver cirrhosis was found in 14 patients (46.7%). The procedures consisted of liver biopsy, liver abscess aspiration, abdominal paracentesis, therapeutic upper gastrointestinal endoscopy, abdominal surgery, endoscopic retrograde cholangiopancreatography and percutaneous transhepatic biliary drainage. After treatment, 25 patients (83.3%) showed a decreased median INR (from 1.6 to 1.3) (p < 0.001, Wilcoxon’s signed-rank test). Five patients failed to show INR reduction. No new bleeding event related to the invasive procedures was observed. Conclusion: PCC treatment is effective to control and prevent bleeding complications in patients with liver coagulopathy who undergo invasive procedures.

scholarly journals Poor Agreement among Prothrombin Time International Normalized Ratio Methods: Comparison of Seven Commercial Reagents

2005 ◽  
Vol 51 (3) ◽  
pp. 553-560 ◽  
Author(s):  
Juha Horsti ◽  
Helena Uppa ◽  
Juhani A Vilpo
Keyword(s):  
Clinical Practice ◽  
Patient Care ◽  
Prothrombin Time ◽  
Oral Anticoagulation ◽  
Anticoagulation Therapy ◽  
International Normalized Ratio ◽  
Poor Agreement ◽  
Oral Anticoagulation Therapy ◽  
The Mean ◽  
The Difference

Abstract Background: Prothrombin time (PT) has long been the most popular test for monitoring oral anticoagulation therapy. The International Normalized Ratio (INR) was introduced to overcome the problem of marked variation in PT results among laboratories and the various recommendations for patient care. According to this principle, all reagents should be calibrated to give identical results and the same patient care globally. This is necessary for monitoring of single patients and for application of the results of anticoagulation trials and guidelines to clinical practice. Methods: We took blood samples from 150 patients for whom oral anticoagulation had been prescribed. Plasmas were separated and PTs determined by use of seven commercial reagents and four calibrator sets. The differences in results were assessed by plotting, for each possible pair of methods, the differences in INR values for each sample against the mean INR value (Bland-Altman difference plots). Results: Mean results differed significantly (P &lt;0.001) for 17 of 21 possible paired comparisons of methods. Only two pairs of methods produced very similar results when assessed for problems of substantial differences in INR values; a significant, systematic increase in the difference with INR; and a significant systematic increase in the variation in difference with increasing INR values. Conclusions: The agreement among several (and perhaps most) commercial INR methods is poor. The failure of current calibration strategies may severely compromise both the monitoring of individual patients and the application of oral anticoagulation guidelines and trial results to clinical practice.

scholarly journals Specialized Management of Oral Anticoagulation Therapy Improves Outcome in Patients with Chronic Renal Insufficiency

2020 ◽  
Vol 9 (3) ◽  
pp. 645
Author(s):  
Michael Lauterbach ◽  
Eduard Uhrich ◽  
Lisa Eggebrecht ◽  
Sebastian Göbel ◽  
Marina Panova-Noeva ◽  
...  
Keyword(s):  
Renal Function ◽  
Usual Care ◽  
Oral Anticoagulation ◽  
Cox Regression ◽  
Anticoagulation Therapy ◽  
Bleeding Events ◽  
Long Term Outcome ◽  
Oral Anticoagulation Therapy ◽  
Hazard Ratios ◽  
The Impact

Oral anticoagulation (OAC) is effective at preventing and treating thromboses and thromboembolism in patients with normal renal function. We aimed to research the impact of severe renal failure (RF) on patient outcome and to determine the potential benefit of caring for these patients in a specialized coagulation service (CS). A total of 1516 usual medical care patients and 756 CS-managed patients of the thrombEVAL multicenter (21 centers), prospective, cohort study (NCT01809015) were analyzed in a 3-year follow-up. Patients with RF (serum creatinine >3 mg/dL, no renal replacement therapy) were compared to patients without RF in usual care and a CS. The fluctuations in the international normalized ratios were significantly lower in CS-managed patients, and regardless of treatment in usual care or a CS, the time in therapeutic range was significantly lower in RF patients. Cox regression-adjusted hazard ratios for long-term outcome (1.5, 95% CI: 1.22–1.83, p < 0.001), death (1.62, CI: 1.27–2.08, p < 0.001), and hospitalization (1.21, CI: 1.02–1.44, p = 0.032) were significantly higher in RF patients in usual care. Furthermore, there was a trend of more bleeding events in RF patients. CS-treated patients had significantly lower adjusted hazard ratios for death (0.24, CI: 0.14–0.39, p < 0.001), hospitalizations (0.41, CI: 0.34–0.5, p < 0.001), clinically relevant bleeding (0.29, CI: 0.18–0.47, p < 0.001), and major bleeding (0.33, CI: 0.18–0.59, p < 0.001). Thus, patients who required oral anticoagulation therapy benefitted significantly from being managed in a specialized coagulation service, regardless of their renal function.

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