A descriptive evaluation of warfarin use in patients receiving hospice or palliative care services

Hill, Robin R.; Martinez, Kerri; Delate, Thomas; Witt, Daniel M.

doi:10.1007/s11239-008-0210-5

Cited by 7 publications

(4 citation statements)

References 10 publications

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“…This is an important outcome because cancer patients with VTE are more likely than a non-cancer patient to experience a recurrent VTE, and recurrent VTE is a substantial burden on both the patient and the healthcare system [19]. Furthermore, warfarin therapy interacts with many chemotherapy agents [20] and INR control is more difficult in cancer patients [21]. Cancer patients frequently require invasive procedures, and coordination of warfarin therapy interruption for these procedures is notoriously challenging [5].…”

Section: Resultsmentioning

confidence: 99%

Outpatient Use of Low Molecular Weight Heparin Monotherapy for First-Line Treatment of Venous Thromboembolism in Advanced Cancer

et al. 2012

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Background. Evidence-based treatment guidelines recommend low molecular weight heparin (LMWH) monotherapy for cancer-associated venous thromboembolism (VTE). This analysis assessed the first-line treatment strategies for VTE in patients with advanced solid tumors.Methods. Using administrative data from advanced lung, prostate, colon, or breast cancer patients diagnosed between January 2000 and December 2007 at four HMOs with integrated delivery systems, patients with an inpatient or outpatient VTE diagnosed within 2 years after cancer diagnosis and an outpatient purchase of warfarin, LMWH, and/or fondaparinux anticoagulant within 7 days of the VTE diagnosis were identified. First-line outpatient VTE pharmacological treatment and factors independently associated with receipt/non-receipt of LMWH monotherapy were assessed.Results. Overall, 25% of the 1,089 eligible patients received LMWH monotherapy as primary VTE treatment.

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Section: Resultsmentioning

confidence: 99%

Outpatient Use of Low Molecular Weight Heparin Monotherapy for First-Line Treatment of Venous Thromboembolism in Advanced Cancer

et al. 2012

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“…17 Secondary endpoints included frequency of INR monitoring per 30 days; proportion of INRs within, above, and below the patient's target range; proportion of INRs <1.5 or >4.5 as consistent with similarly designed studies; and incidence of bleeding or thromboembolic adverse events during the study period. 18,19 Thromboembolic complications were defined as objectively confirmed deep vein thrombosis, pulmonary embolism, cerebrovascular event, transient ischemic attack, systemic thromboembolism, or heart valve thrombosis. Bleeding complications, including intracranial hemorrhage, gastrointestinal tract hemorrhage, hematoma, hemoptysis, epistaxis, and hematuria, were included if the patient sought care through a medical office, urgent care, or emergency department visit, or if it resulted in hospitalization, regardless of severity.…”

Section: Study Outcomesmentioning

confidence: 99%

Evaluation of Warfarin Use in Patients With Mental Health Conditions in a Rural Community Health Center System

Abell

Irwin

2020

Journal of Pharmacy Technology

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Background: Mental health conditions (MHCs) may affect a patient’s ability to comply with requirements necessary for safe warfarin use. Objective: To describe warfarin control, defined as time in therapeutic range (TTR), for patients with and without MHCs receiving care through a pharmacist-driven anticoagulation service within a rural community health center system. Methods: Retrospective cohort study of patients on warfarin between January 1, 2014, and December 31, 2017. The primary study endpoint was TTR. Secondary endpoints were the number of international normalized ratios (INRs) per 30 days, percentage of INRs within, above, and below target range, and warfarin-related adverse events. Results: A total of 79 patients were included—37 with and 42 without MHCs. Patients were mostly male (n = 47; 59.5%) and prescribed warfarin for atrial fibrillation (n = 45; 57.0%). There were no differences in overall TTR between those with (59.6%; interquartile range = 41.8-73.4) versus without (63.4%; interquartile range = 46.7-73.6) MHCs ( P = .542). Secondary outcomes showed no differences in the frequency or percentage of INRs in, above, or below target range (all P > .05). However, there were about twice as many hemorrhagic complications in the group with MHCs (27% vs 11.9%; P = .149). Conclusion: Patients with MHCs experienced no difference in overall TTR as compared to patients without MHCs. However, there was a non-statistically significant reduction in TTR, which would be consistent with limited existing data and demonstrates possible reproducibility to a rural, underserved patient population. Future research is needed to validate these outcomes.

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“…Oncology patients have a higher rate of VTE recurrences during oral anticoagulant therapy with VKAs and a higher anticoagulation-associated hemorrhagic risk as compared with noncancer patients 25. Warfarin therapy interacts with many chemotherapy agents, and INR control is difficult to achieve in cancer patients 26,27. The frequent need for invasive techniques and coordination of warfarin therapy interruption with these procedures is notoriously challenging 28.…”

Section: Treatment Of Thrombosis In Cancer Patientsmentioning

confidence: 99%

“…25 Warfarin therapy interacts with many chemotherapy agents, and INR control is difficult to achieve in cancer patients. 26,27 The frequent need for invasive techniques and coordination of warfarin therapy interruption with these procedures is notoriously challenging. 28 Finally, the association between VKAs and genetic determinants has been consistently identified.…”

Section: Treatment Of Thrombosis In Cancer Patientsmentioning

confidence: 99%

What is the Best Treatment for a Cancer Patient with Thrombosis?

Barbosa

2014

Clin Med Insights Oncol

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The relationship between venous thromboembolism and cancer has been known for many years, and there is solid scientific evidence addressing the adequate treatment of this condition in oncology patients. However, established prescribing habits, individual patient challenges, and uncertainty concerning treatment justifies poor adherence to published guidelines. This paper reviews venous thromboembolism treatment while focusing on vitamin K antagonists, low-molecular-weight heparins, and novel oral anticoagulants, namely in terms of their efficacy and limitations.

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A descriptive evaluation of warfarin use in patients receiving hospice or palliative care services

Abstract: Patients in HPC required more frequent INR monitoring but had similar risks for warfarin-related adverse events.

Cited by 7 publications

References 10 publications

Outpatient Use of Low Molecular Weight Heparin Monotherapy for First-Line Treatment of Venous Thromboembolism in Advanced Cancer

Outpatient Use of Low Molecular Weight Heparin Monotherapy for First-Line Treatment of Venous Thromboembolism in Advanced Cancer

Evaluation of Warfarin Use in Patients With Mental Health Conditions in a Rural Community Health Center System

What is the Best Treatment for a Cancer Patient with Thrombosis?

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