Care of Patients Receiving Long-Term Anticoagulant Therapy

Schulman, Sam

doi:10.1056/nejmcp025373

Cited by 215 publications

(152 citation statements)

References 65 publications

(19 reference statements)

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“…3,4 If left untreated, patients with atrial fibrillation typically have a mortality risk 2.5 times higher than anticoagulated controls. 5 Despite compelling clinical indication, not all patients requiring stroke prophylaxis receive warfarin anticoagulation.…”

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confidence: 99%

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Impact of Age, CYP2C9 Genotype and Concomitant Medication on the Rate of Rise for Prothrombin Time During the First 30 Days of Warfarin Therapy

Wilke¹,

Berg²,

Vidaillet³

et al. 2005

Clinical Medicine & Research

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Objectives:To characterize the impact of several important clinical variables on the rate of anticoagulation during warfarin initiation (i.e., the first 30 days).Design: Retrospective study.Setting: An anticoagulation service of a large horizontally integrated, multispecialty group practice in central and northern Wisconsin. Participants:Patients with sufficient laboratory data obtained during the initiation phase of warfarin treatment. Methods:Patients were consented and genotyped for cytochrome P450 (CYP) 2C9 polymorphisms. Anticoagulation laboratory data were then electronically abstracted and fitted to a logistic growth model. Rate of anticoagulation was compared between groups.Results: During warfarin initiation, the mean slope for rise in International Normalized Ratio (INR) of prothrombin time was significantly associated with age (p=0.03, n=166). Because a relationship between diabetes and warfarin dosing has been suggested previously, we assessed the impact of this comorbidity in our model as well. Diabetes showed relatively little impact, but concomitant treatment with an anti-diabetic sulfonylurea medication was associated with an increase in slope (3-fold, p<0.05).

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confidence: 99%

“…9 Although diabetes is known to be associated with hypercoagulable states, the pathogenetic mechanism appears to involve platelet dysfunction rather than a disruption of clotting factor homeostasis. 4,[10][11][12][13][14][15][16][17][18] Other factors (e.g., comorbidity or concomitant medication) are therefore likely to contribute to this interaction.…”

mentioning

confidence: 99%

Impact of Age, CYP2C9 Genotype and Concomitant Medication on the Rate of Rise for Prothrombin Time During the First 30 Days of Warfarin Therapy

Wilke¹,

Berg²,

Vidaillet³

et al. 2005

Clinical Medicine & Research

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“…The prophylactic anticoagulant therapy is generally not indicated in patients who have not developed a thrombotic event, but these patients were found positive for heterozygous factor V leiden mutation due to family testing. The duration of treatment depend on unprovoked or provoked reasons of thrombosis, site of thrombosis, family history, risk factors involved and type of thrombophilia, ranging from 6 months to indefinite [13,14].…”

Section: Discussionmentioning

confidence: 99%

Ischemic Stroke in a Patient with Hetrozygous Factor V Leiden Mutation: An Uncommon Association

Duhan

Chaudhary

et al. 2014

Indian J Hematol Blood Transfus

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“…Para o tratamento de doenças relacionadas com a coagulação são utilizados Anticoagulantes Orais (ACOs) e entre os ACOs de uso comunitário destaca-se a varfarina (ANSELL et al, 2004;SCHULMAN, 2003). Este fármaco apresenta janela terapêutica estreita, grande variabilidade de resposta terapêutica, elevada frequência de interações alimentares e medicamentosas (ANSELL et al, 2004;GUYATT et al, 2012;BONATE et al, 2016).…”

Section: Introductionunclassified

“…Budnitz et al (2011) complementam afirmando que dois terços das hospitalizações de idosos nos Estados Unidos (2007)(2008)(2009)) estão relacionados com uso de medicamentos, entre os quais se destaca a varfarina. Já no estudo de Schulman (2003) a varfarina foi responsável por 50% das internações, principalmente devido à hemorragia, com incidência de 0,5% a 4,2% para hemorragia intracraniana e de 2% a 24% para episódios menores de sangramento.…”

Section: Introductionunclassified

Acompanhamento Farmacoterapêutico De Pacientes Em Uso De Varfarina: Uma Revisão Da Literatura

Colet

Amador

Heineck³

2017

Rev. Cont. Saúde

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RESUMOIntrodução: A varfarina é um dos Anticoagulantes Orais (ACOs) mais utilizados na atenção primária à saúde. Com janela terapêutica estreita, exibe extensa variabilidade de resposta farmacológica e grande suscetibilidade de eventos adversos, como sangramentos e tromboembolismo venoso. Objetivos: realizar uma revisão da literatura sobre o acompanhamento farmacoterapêutico de pacientes ambulatoriais em uso de varfarina. Método: Trata-se de um estudo de revisão. As palavras-chave usadas para a seleção dos artigos foram: Varfarina, Acompanhamento, Farmácia Clínica, Anticoagulantes Orais. Resultados: O uso de varfarina está associado com eventos adversos, sendo mais frequentes as hemorragias, que podem ser prevenidas com monitorização da Razão Normalizada Internacional (INR). A monitorização da coagulação sanguínea é de extrema importância para controlar a eficácia e a adesão do paciente ao tratamento com o anticoagulante. Em um ambulatório multiprofissional para pacientes em tratamento com varfarina identificou-se um aumento do percentual de pacientes com INR na faixa terapêutica com o prolongamento do tempo de acompanhamento no ambulatório. Pacientes atendidos em clínicas de anticoagulação tendem a apresentar mais valores de INR na faixa terapêutica, variando de 60% a 88%. Outro resultado importante relacionado com as clínicas foi a menor frequência de INRs supraterapêuticos e maior tempo na faixa terapêutica. Além disso, o acompanhamento por farmacêutico pode resultar em menores custos de cuidados e de eventos adversos relacionados com a anticoagulação, admissões hospitalares e busca por serviços de emergência. Quando os ACOs são administrados por farmacêuticos, parece haver um tempo mais curto para estabilização da terapia e uma maior percentagem de tempo no intervalo terapêutico, bem como uma diminuição da frequência de erros de medicação, maior tempo na faixa de INR terapêutico e redução das principais interações medicamentosas. ABSTRACT Introduction: Warfarin is one of the most commonly used oral anticoagulants (OACs) in primary health care. With narrow therapeutic window, it exhibits great variability of pharmacological response, and great susceptibility of adverse events, such as bleeding and venous thromboembolism. Objectives: To carry out a review of the literature on pharmacotherapeutic follow-up of outpatients using warfarin. Method: This is a review study. The keywords used for the selection of the articles were: Warfarin, Therapeutic Monitoring, Clinical Pharmacy, Oral Anticoagulants. Results: The use of warfarin is associated with adverse events, with hemorrhages being the most frequent, which can be prevented with INR monitoring. Monitoring of blood coagulation is of paramount importance in controlling patient efficacy and adherence to anticoagulant treatment. In a multiprofessional outpatient clinic for patients receiving warfarin, an increase was observed in the percentage of patients with INR in the therapeutic range, with the prolongation of the follow-up time in the outpatient clinic. Patien...

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Care of Patients Receiving Long-Term Anticoagulant Therapy

Cited by 215 publications

References 65 publications

Impact of Age, CYP2C9 Genotype and Concomitant Medication on the Rate of Rise for Prothrombin Time During the First 30 Days of Warfarin Therapy

Impact of Age, CYP2C9 Genotype and Concomitant Medication on the Rate of Rise for Prothrombin Time During the First 30 Days of Warfarin Therapy

Ischemic Stroke in a Patient with Hetrozygous Factor V Leiden Mutation: An Uncommon Association

Acompanhamento Farmacoterapêutico De Pacientes Em Uso De Varfarina: Uma Revisão Da Literatura

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