Assessment of Anticoagulation Control Association with Warfarin Knowledge and Demographic Features of Iranian Population

Background: Warfarin is the most commonly used oral anticoagulant for patients with atrial fibrillation, prosthetic heart valves, and deep vein thrombosis with a narrow therapeutic index. Due to the importance of patients’ adherence to treatment and also regular measurements of International normalized ratio (INR), this can have a significant impact on the quality of anticoagulation control. Objectives: The primary aim of this study was to assess the association between warfarin knowledge and time in therapeutic range (TTR) in patients on warfarin anticoagulation for at least 6 months who were referred to anticoagulation clinic in Rajaie Heart Center during 2016 - 2017. Methods: In this cross-sectional study, 620 patients who had been referred to the outpatient Rajaie Hospital anticoagulant clinic and had been taking warfarin for over six months were asked to fill two questionnaires named anticoagulation knowledge assessment (AKA) during a 12-week period. After obtaining the necessary permits, TTR (by Rosendal method) was calculated using the INR results of patients. Results: A total of 620 patients completed the questionnaire. The relation between warfarin knowledge and anticoagulation control was not significant. The mean age of the study population was 52.45 SD ± 14.01 years. This study showed a significant relationship between TTR, duration of warfarin usage (PV = 0.03) and the underlying cause of this usage (PV = 0.016). Conclusions: Prevention of chronic diseases is one of the most important priorities of the health care systems. Reduction in complications such as thrombosis and bleeding can be achieved by efforts to promote patient’s knowledge. By recognition of relation between warfarin knowledge and social and demographic indicators, patient’s education gap can be detected and also planned for dissolving. This study showed that although many of the patients visited in anticoagulation clinic have poor anticoagulation control, but a major part of them have good knowledge of warfarin usage.

Download Full-text

Risk factors for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage

Open Medicine ◽

10.1515/med-2020-0169 ◽

2020 ◽

Vol 15 (1) ◽

pp. 598-604

Author(s):

Valentina Opancina ◽

Snezana Lukic ◽

Slobodan Jankovic ◽

Radisa Vojinovic ◽

Milan Mijailovic

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Cerebral Vasospasm ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Medical Center ◽

White Blood Cells ◽

Cerebral Aneurysms ◽

International Normalized Ratio ◽

Cross Sectional Study ◽

Cross Sectional

AbstractIntroductionAneurysmal subarachnoid hemorrhage is a type of spontaneous hemorrhagic stroke, which is caused by a ruptured cerebral aneurysm. Cerebral vasospasm (CVS) is the most grievous complication of subarachnoid hemorrhage (SAH). The aim of this study was to examine the risk factors that influence the onset of CVS that develops after endovascular coil embolization of a ruptured aneurysm.Materials and methodsThe study was designed as a cross-sectional study. The patients included in the study were 18 or more years of age, admitted within a period of 24 h of symptom onset, diagnosed and treated at a university medical center in Serbia during a 5-year period.ResultsOur study showed that the maximum recorded international normalized ratio (INR) values in patients who were not receiving anticoagulant therapy and the maximum recorded white blood cells (WBCs) were strongly associated with cerebrovascular spasm, increasing its chances 4.4 and 8.4 times with an increase of each integer of the INR value and 1,000 WBCs, respectively.ConclusionsSAH after the rupture of cerebral aneurysms creates an endocranial inflammatory state whose intensity is probably directly related to the occurrence of vasospasm and its adverse consequences.

Download Full-text

IgA Anticardiolipin Antibodies – Relation with other Antiphospholipid Antibodies and Clinical Significance

Thrombosis and Haemostasis ◽

10.1055/s-0037-1614978 ◽

1998 ◽

Vol 79 (02) ◽

pp. 282-285 ◽

Cited By ~ 49

Author(s):

Josep Ordi-Ros ◽

Francesc Monegal-Ferran ◽

Nuria Martinez ◽

Fina Cortes-Hernandez ◽

Miquel Vilardell-Tarres ◽

...

Keyword(s):

Lupus Erythematosus ◽

Antiphospholipid Antibodies ◽

Fetal Loss ◽

Cross Sectional Study ◽

Anticardiolipin Antibodies ◽

Antiphospholipid Antibody ◽

Antiphospholipid Antibody Syndrome ◽

Serum Samples ◽

Cross Sectional ◽

Vein Thrombosis

SummaryObjective: To evaluate the usefulness of IgA antiphospholipid antibodies as markers of thrombosis and/or antiphospholipid antibody syndrome. Patients and Methods: A cross-sectional study design in a tertiary, university-based, autoimmune reference hospital. Seven-hundred ninety-five patients classified into five different groups – autoimmune diseases (255), deep vein thrombosis (153), transitory ischemic attacks (108), obstetric complications (196), infectious diseases (83) and controls (81) – were tested for IgA, IgG and IgM aPL, and lupus anticoagulant. Plasma and serum samples were drawn for detection of aPL using an internationally standardized ELISA method and LA was carried out using coagulometric assays. Results: True IgA aPL were found only in two patients with systemic lupus erythematosus; these patients were also positive to IgG aPL. Conclusion: The incidence of true positivity to IgA anticardiolipin antibodies is extremely low. Their determination was not helpful in diagnosing the antiphospholipid syndrome or in explaining thrombotic events or aPL related manifestations – fetal loss – in the groups studied.

Download Full-text

Changes in Prescribing Antithrombotic Therapy in Patients with Atrial Fibrillation in the Multidisciplinary Hospital in Volgograd from 2012 to 2020

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2021-12-06 ◽

2022 ◽

Vol 17 (6) ◽

pp. 831-836

Author(s):

A. S. Gerasimenko ◽

O. V. Shatalova ◽

V. S. Gorbatenko ◽

V. I. Petrov

Keyword(s):

Atrial Fibrillation ◽

Clinical Practice ◽

Clinical Guidelines ◽

Antithrombotic Therapy ◽

Heart Valves ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

International Normalized Ratio ◽

Prosthetic Heart Valves ◽

Discharge From Hospital

Aim. To study the frequency of prescribing antithrombotic agents in patients with non-valvular atrial fibrillation (AF) in real clinical practice, to evaluate changes of prescriptions from 2012 till 2020.Material and methods. The medical records of inpatients (Form 003/y) with the diagnosis AF, hospitalized in the cardiological department were analyzed. According to the inclusion criteria, the patients were over 18 years of age, established diagnosis of non-valvular AF. There were two exclusion criteria: congenital and acquired valvular heart disease and prosthetic heart valves. In retrospective analysis we have included 263 case histories in 2012, 502 ones in 2016 and 524 in 2020. CHA2DS2-VASc score was used for individual stroke risk assessment in AF. The rational use of the antithrombotic therapy was evaluated according with current clinical practice guidelines at analyzing moment.Results. During period of observation the frequency of antiplatelet therapy significantly decreased from 25,5% to 5,5% (р<0.001), decreased the frequency of administration of warfarin from 71,9% to 18,3% (р<0.001). The frequency of use of direct oral anticoagulants increased in 2020 compared to 2016 (р<0.001). For patients with a high risk of stroke anticoagulant therapy was administered in 71.8% of cases in 2012, 88.5% in 2016 and 92.5% in 2020. Before discharge from hospital majority of patients (72%) achieved a desired minimum international normalized ratio (INR) from 2.0 to 3.0 in 2012. In 2016 and 2020 an only 33% and 40.6% of patients achieved INR (2.0-3.0).Conclusion. Doctors have become more committed to following clinical guidelines during the period of the investigation. In 2020 antithrombotic therapy for atrial fibrillation was suitable according to current clinical guidelines.

Download Full-text

A Cross-sectional Study on Challenges Faced and Strategies Adopted in Responding to Corona Virus Disease (COVID-19) by Hospital Administrators in Kaski District

Journal of Biomedical Research & Environmental Sciences ◽

10.37871/jbres1221 ◽

2021 ◽

Vol 2 (4) ◽

pp. 256-260

Author(s):

KC Deepti ◽

S Poudel ◽

SB Hamal Thakuri ◽

S Shrestha

Keyword(s):

Virus Disease ◽

Health Care Systems ◽

Structured Interview ◽

Cross Sectional Study ◽

Public Hospitals ◽

Cross Sectional ◽

Hospital Administrators ◽

Corona Virus ◽

Care Systems ◽

Private And Public

Background: Following the outbreak of Coronavirus disease in 2019, the year 2020/21 has been an incredibly challenging one for all global health-care systems. Methods: A cross sectional descriptive research design was used to conduct the study. The study was carried out in all general private and public hospitals of Kaski district of Nepal. Data were collected from 25th October to 5th December, 2020 from the Hospital administrators using a semi structured interview schedule. Descriptive statistics were used for data analysis. Results: Most (96.3%) of the hospitals reported that increased cost or expenses of the hospitals creating financial threat is the most challenging situation that hospitals are facing in this pandemic. In addition shortages of ventilators creating ethical dilemma for patient allocation and changing guidelines from authorities have been reported as a challenge by 88.9 percent of the hospitals respectively. All of the surveyed hospitals had developed the use of thermometers for screening at the hospital entrances to minimize the risk. Conclusion: Hospitals in this pandemic are facing a lot of challenges with regard to staff management, PPE management and so on. Hence they need to adopt best strategies in responding to the corona virus.

Download Full-text

Do People with Type 2 Diabetes Think They are Unhealthy? A Cross-Sectional Study in Celaya, Mexico

Central Asian Journal of Global Health ◽

10.5195/cajgh.2015.207 ◽

2015 ◽

Vol 4 (1) ◽

Author(s):

Karla C. Paz-Salinas ◽

Nicolas Padilla-Raygoza ◽

Silvia C. Delgado-Sandoval ◽

Georgina Olvera-Villanueva ◽

Ma Laura Ruiz-Paloalto

Keyword(s):

Type 2 Diabetes ◽

Diabetes Management ◽

Healthy Lifestyle ◽

Health Care Systems ◽

Cross Sectional Study ◽

Normal Weight ◽

Cross Sectional ◽

Exact Test ◽

Perception Of Health

Background: Type 2 diabetes is a chronic disease that presents a significant burden on health care systems in many countries. With the rise of obesity, the incidence of Type 2 diabetes has also been steadily increasing. A healthy lifestyle and understanding of diabetes management are important factors for delaying the onset of comorbidities associated with Type 2 diabetes. The objective of this study was to evaluate the self-perception of health in individuals with Type 2 diabetes as it relates to BMI status, which has important implications for the implementation of preventive programs. Methods: A cross-sectional lifestyle survey was implemented in the region of Celaya, Guanajuato, Mexico, targeting 100 participants diagnosed with Type 2 diabetes. Anthropometric measurements and participant characteristics were also obtained. Fisher’s exact test was used to determine if the proportions of lifestyles perceptions differed by BMI status. Results: Participants had a mean age of 56.12 ± 10.26, a mean BMI of 29.13 ± 5.48 kg/m2, were mostly married (67.0%), and female (70.0%). None of the normal weight participants perceived themselves as unhealthy. 95% of overweight/obese participants perceived themselves to be healthy, despite a diagnosis of diabetes and being overweight/obese, while only 5% perceived themselves to be unhealthy. However, these differences in the perceptions of health classified by BMI status were not statistically significant (p = 0.42).Conclusion: Our findings indicate that overweight and obese persons with Type 2 diabetes in Celaya, Mexico may have misperceptions about their own health, even though these findings were not statistically significant. These preliminary data highlight the importance of implementing prevention and educational programs among those with diabetes, in order to combat health misperceptions and raise awareness about the dangers of diabetes and obesity. Furthermore, more research with larger sample sizes is needed in order to fully understand the effects of perception of health on actual health.

Download Full-text

Warfarin Safety: A Cross-Sectional Study of the Factors Associated with the Consumption of Medicinal Plants in a Brazilian Anticoagulation Clinic

American Journal of Cardiovascular Drugs ◽

10.1007/s40256-018-0268-1 ◽

2018 ◽

Vol 18 (3) ◽

pp. 231-243 ◽

Cited By ~ 4

Author(s):

Paula Mendonça Leite ◽

Aline A. de Freitas ◽

Aline de O. Magalhães Mourão ◽

Maria A. P. Martins ◽

Rachel O. Castilho

Keyword(s):

Medicinal Plants ◽

Cross Sectional Study ◽

Anticoagulation Clinic ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated

Download Full-text

A NOVEL TOOL FOR THE EARLY IDENTIFICATION OF FRAILTY IN ELDERLY PEOPLE: THE APPLICATION IN PRIMARY CARE SETTINGS

Journal of Frailty & Aging ◽

10.14283/jfa.2019.41 ◽

2019 ◽

pp. 1-6

Author(s):

M. Maggio ◽

M. Barbolini ◽

Y. Longobucco ◽

L. Barbieri ◽

C. Benedetti ◽

...

Keyword(s):

Primary Care ◽

Construct Validity ◽

Predictive Value ◽

Community Health Centers ◽

Health Care Systems ◽

Cross Sectional Study ◽

Criterion Validity ◽

Cross Sectional ◽

Care Systems ◽

The One

Objectives: Frailty is a pre-disability condition in older persons providing a challenge to Health-Care Systems. Systematic reviews highlight the absence of a gold-standard for its identification. However, an approach based on initial screening by the General Practitioner (GP) seems particularly useful. On these premises, a 9-item Sunfrail Checklist (SC), was developed by a multidisciplinary group, in the context of European Sunfrail Project, and tested in the Community. Objectives: – to measure the concordance between the judgments of frailty (criterion-validity): the one formulated by the GP, using the SC, and the one subsequently expressed by a Comprehensive Geriatric Assessment Team (CGA-Team); – to determine the construct-validity through the correspondence between some checklist items related to the 3 domains (physical, cognitive and social) and the three tools used by the CGA-Team; – to measure the instrument’s performance in terms of positive predictive value (PPV) and negative predictive value (NPV). Design: Cross-sectional study, with a final sample-size of 95 subjects. Setting: Two Community-Health Centers of Parma, Italy. Participants: Subjects aged 75 years old or more, with no disability and living in the community. Measurements: We compared the screening capacity of the GP using the SC to that one of CGA-Team based on three tests: 4-meter Gait-Speed, Mini-Mental State Examination and Loneliness Scale. Results: 95 subjects (51 women), with a mean age of 81±4 years were enrolled. According to GPs 34 subjects were frail; the CGA-Team expressed a frailty judgment on 26 subjects. The criterion-validity presented a Cohen’s k of 0.353. Construct-validity was also low, with a maximum contingency-coefficient of 0.19. The analysis showed a PPV of 58.1% and a NPV equal to 84.6%. Conclusions: Our data showed a low agreement between the judgements of GP performed by SC and CGA-Team. However, the good NPV suggests the applicability of SC for screening activities in primary-care.

Download Full-text

Awareness and Perception of Thromboembolism and Thromboprophylaxis among Hospitalized Patients in Jordan

Current Clinical Pharmacology ◽

10.2174/1574884714666190823162055 ◽

2020 ◽

Vol 15 (1) ◽

pp. 72-80

Author(s):

Anan S. Jarab ◽

Sayer Al-Azzam ◽

Rawan Badaineh ◽

Tareq L. Mukattash ◽

Razan Bsoul

Keyword(s):

Educational Level ◽

Cross Sectional Study ◽

Hospitalized Patients ◽

Personal History ◽

High Educational Level ◽

Cross Sectional ◽

Vein Thrombosis ◽

Validated Questionnaire ◽

History Of ◽

Study Participants

Background and Objective: Despite the established importance of thromboprophylaxis in patients with Venous Thromboembolism (VTE), a limited number of studies have assessed the awareness of VTE and thromboprophylaxis therapy among the affected patients. The aim of the current study was to assess awareness and to explore variables associated with awareness about VTE and its thromboprophylaxis. Methods: A cross-sectional study was conducted on hospitalized patients who received thromboprophylaxis (5000 units of heparin subcutaneously (SC) q8-12h, or 30-40 mg of enoxaparin SC once daily). In addition to the sociodemographic variables, awareness and perception of VTE and its thromboprophylaxis were assessed using a validated questionnaire. Multiple logistic regressions were conducted to build a model of variables significantly associated with VTE awareness. Results: A total of 225 patients participated in the study, with only 38.2% and 22.2% of the participants being aware of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) respectively. Logistic regression showed that the participants with low educational level had 3.046 value, with the odds being not aware of DVT or PE compared with participants with high educational level. Participants without a personal history of VTE had 7.374 value, with the odds being not aware of DVT or PE compared with those who had a personal history of VTE. Participants who had a negative perception of VTE had 2.582 value, with the odds being not aware of DVT or PE compared with participants who had a positive perception and those who did not have any information about DVT or PE had 13.727 value, with the odds being not aware of DVT or PE. Conclusion: The findings reveal that there is a lack of awareness about VTE and its thromboprophylaxis among the study participants. Patients with lower educational level and those with no history of previous VTE need awareness improvement about VTE and its thromboprophylaxis. Clinical Pharmacists need to focus on providing information about VTE and improving patients’ perception about VTE and its thromboprophylaxis with the aim of improving the awareness about VTE, and hence the better health outcome.

Download Full-text