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.

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.

MO738CLINICAL IMPACT OF ORAL ANTICOAGULATION THERAPY ON MORTALITY, EMBOLIC AND HEMORRHAGIC EVENTS IN CHRONIC HEMODIALYSIS PATIENTS WITH ATRIAL FIBRILLATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Zorica Dimitrijevic ◽  
Sonja Salinger ◽  
Danijela Tasic ◽  
Miomir Stojanovic ◽  
Karolina Paunovic ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Oral Anticoagulation ◽  
Anticoagulation Therapy ◽  
Bleeding Risk ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Bleeding Events ◽  
Hemorrhagic Events ◽  
The Impact ◽  
Anticoagulated Patients

Abstract Background and Aims A balance between embolic and bleeding risk is challenging in patients on chronic hemodialysis (HD). Embolic prevention with oral anticoagulation is the cornerstone for managing patients with atrial fibrillation (AF). However, there is a lack of specific recommendations for the use of antithrombotic therapy in HD patients with AF, and data about the efficacy and safety of oral anticoagulation in those patients are limited. Anticoagulation may exacerbate the hemorrhagic tendency; therefore, its potential benefits must be carefully weighed against hemorrhagic complications. We aimed to analyze the impact of oral anticoagulation on mortality, embolic and hemorrhagic events in chronic hemodialysis patients with AF. Method We used data from 106 hemodialysis patients [median age of 72 years (IQR 59–79) and 74.8% of the male gender] diagnosed with AF between 2016 and 2019. An analysis was performed to match the baseline characteristics of patients treated or not with oral vitamin K antagonists (OAK). The impact of oral anticoagulation in the embolic and hemorrhagic risk was assessed by a competitive risk analysis, with death being the competitive event. For embolic risk, we have considered a stroke, pulmonary or peripheral embolism, including arteriovenous fistula thrombosis. For bleeding risk, we have considered major bleeding according to the ISTH definition. Results More than half of HD patients with AF were anticoagulated (65.1%; n=69). During a median follow-up of 27.6 months (IQR 11.8-42.9 months), 33 patients died (31.1%), 21 presented embolic events (19.8%), and 19 had a major bleeding event (17.9%). In total, we recorded eight cerebral bleedings, ten gastrointestinal bleedings, and one urogenital bleeding. Of those, eleven (57.9%) were observed in orally anticoagulated patients (p=0.066). Patients with bleeding events had a higher prevalence of arterial hypertension (p=0.012), diabetes mellitus (p=0.002), advanced age (p=0.03) lower platelets count (p&lt;0.001) and lower hemoglobin (p=0.04). After propensity-score matching, anticoagulation therapy was associated with lower mortality rate (HR 0.86, 95% CI 0.71-0.92; p=0.004) and embolic events (HR 0.78, 95% CI 0.69-0.88; p=0.003), but more bleeding events (HR 1.83, 95% CI 1.34-2.91; p=0.002). Conclusion Among HD patients with AF, oral anticoagulation was associated with lower all-cause mortality. Although survival free of embolic events was significantly higher in patients with anticoagulation, the risk of major bleeding was almost twice than in non-anticoagulated patients. Patients who experienced bleeding events did not show worse outcomes. This study strengthens the role of low hemoglobin and platelet counts as well as comorbidities on increased bleeding risk.

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.

No Increased Bleeding Events with Continuation of Oral Anticoagulation Therapy for Patients Undergoing Cardiac Device Procedure

2011 ◽  
Vol 34 (7) ◽  
pp. 868-874 ◽  
Author(s):  
HUNG-KEI LI ◽  
FRANK C. CHEN ◽  
ROBERT F. REA ◽  
SAMUEL J. ASIRVATHAM ◽  
BRIAN D. POWELL ◽  
...  
Keyword(s):  
Oral Anticoagulation ◽  
Anticoagulation Therapy ◽  
Bleeding Events ◽  
Cardiac Device ◽  
Oral Anticoagulation Therapy

Ervaringen tijdens de "Belgian Improvement Study on Oral Anticoagulation Therapy" (BISOAT)

2005 ◽  
Vol 61 (11) ◽  
pp. 841-847 ◽  
Author(s):  
CLAES N ◽  
BUNTINX F ◽  
VIJGEN J ◽  
ARNOUT J ◽  
VERMYLEN J ◽  
...  
Keyword(s):  
Oral Anticoagulation ◽  
Anticoagulation Therapy ◽  
Oral Anticoagulation Therapy

Depression and Uptake of Oral Anticoagulation Therapy in Patients With Atrial Fibrillation

Medical Care ◽  
2020 ◽  
Vol 58 (3) ◽  
pp. 216-224 ◽  
Author(s):  
Morten Fenger-Grøn ◽  
Claus H. Vestergaard ◽  
Lars Frost ◽  
Dimitry S. Davydow ◽  
Erik T. Parner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Anticoagulation Therapy ◽  
Oral Anticoagulation Therapy

Consideration of non-valvular atrial fibrillation with left atrial appendage thrombus formation despite under appropriate oral anticoagulation therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Shiraki ◽  
H Tanaka ◽  
K Yamashita ◽  
Y Tanaka ◽  
K Sumimoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Oral Anticoagulation ◽  
Left Atrial ◽  
Thrombus Formation ◽  
Anticoagulation Therapy ◽  
Left Ventricular ◽  
Volume Index ◽  
Oral Anticoagulation Therapy

Abstract Background Atrial fibrillation (AF) is the most frequently sustained cardiac arrhythmia, with a prevalence of about 2–3% in the general population. In accordance with CHADS2 or CHA2DS2-VASc score, appropriate oral anticoagulation therapy such as warfarin or direct oral anticoagulants (DOAC) significantly reduced the risk of thromboembolic events. However, left atrial (LA) thrombus can be detected in the LA appendage (LAA) in AF patients despite appropriate oral anticoagulation therapy. Purpose Our purpose was to investigate the associated factors of LAA thrombus formation in non-valvular atrial fibrillation (NVAF) patients despite under appropriate oral anticoagulation therapy. Methods We retrospectively studied consecutive 286 NVAF patients for scheduled catheter ablation or electrical cardioversion for AF in our institution between February 2017 and September 2019. Mean age was 67.1±9.4 years, 79 patients (29.5%) were female, and 140 (52.2%) were paroxysmal AF. All patients underwent transthoracic and transesophageal echocardiography before catheter ablation or electrical cardioversion. All patients received appropriate oral anticoagulation therapy including warfarin or DOAC for at least 3 weeks prior to transesophageal echocardiography based on the current guidelines. LAA thrombus was defined as an echodense intracavitary mass distinct from the underlying endocardium and not caused by pectinate muscles by at least three senior echocardiologists. Results Of 286 NVAF patients with under appropriate oral anticoagulation therapy, LAA thrombus was observed in 9 patients (3.3%). Univariate logistic regression analysis showed that age, paroxysmal AF, CHADS2 score ≥3, left ventricular end-diastolic volume index (LVEDVI), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), LA volume index (LAVI), mitral inflow E and mitral e' annular velocities ratio (E/e'), and LAA flow were associated with LAA thrombus formation. It was noteworthy that multivariate logistic regression analysis showed that LAA flow was independent predictor of LAA thrombus (OR: 0.72, 95% CI: 0.59–0.89, p&lt;0.005) as well as LVEF. Furthermore, receiver operating characteristic (ROC) curve analysis identified the optimal cutoff value of LAA flow for predicting LAA thrombus as ≤15cm/s, with a sensitivity of 88%, specificity of 93%, and area under the curve (AUC) of 0.95. Conclusions LAA flow was strongly associated with LAA thrombus formation even in NVAF patients with appropriate oral anticoagulation therapy. According to our findings, further strengthen of oral anticoagulation therapy or percutaneous transcatheter closure of the LAA may be considered in NVAF patients with appropriate oral anticoagulation therapy but low LAA flow, especially &lt;15cm/s. Funding Acknowledgement Type of funding source: None

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