Dementia and Risk of Adverse Warfarin-Related Events in the Nursing Home Setting

Tjia, Jennifer; Mazor, Kathleen M.; Donovan, Jennifer L.; Kanaan, Abir O.; Reed, George W.; Doherty, Peter; Harrold, Leslie R.; Gurwitz, Jerry H.

doi:10.1016/j.amjopharm.2012.09.003

Cited by 16 publications

(22 citation statements)

References 25 publications

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“…First, swallowing and eating difficulties make giving medication burdensome and difficult for the residents and the nursing home staff. 26 Second, adverse drug effects (ADEs) are common in patients with dementia, 27–30 yet ADEs are difficult to detect by clinicians because these patients have difficulty expressing the symptoms they feel. 31,32 Third, this population has frequent clinical complications associated with a high risk of 6-month mortality, and the time to benefit from many medications exceeds this life expectancy.…”

Section: Discussionmentioning

confidence: 99%

Use of Medications of Questionable Benefit in Advanced Dementia

Tjia

Briesacher

Peterson³

et al. 2014

JAMA Intern Med

Self Cite

105

102

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Section: Discussionmentioning

confidence: 99%

Use of Medications of Questionable Benefit in Advanced Dementia

Tjia

Briesacher

Peterson³

et al. 2014

JAMA Intern Med

Self Cite

105

102

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“…Only 2 older studies on warfarin reported on cognitive function or falls in relation to treatment [18,19], but none for the other drugs. In an earlier uncontrolled trial even the hypothesis was derived that dementia may be prevented by warfarin [20], and a relation between anticoagulation control and dementia was reported [21]. A current metaanalysis suggests a possible cognitive benefit of anticoagulation [22].…”

Section: Key Findings On Oral Anticoagulants Appropriatenessmentioning

confidence: 99%

“…[20][21][22][23][24]), but not included in this structured comprehensive review, point to the importance of data from studies or even case reports not fulfilling inclusion criteria of RCTs commonly required for such reviews. This instrument thus does not cover all evidences available, though even regulatory action including "dear doctor letters" may be triggered by these observations such as for bleeding complications of dabigatran treatment in 2011 in Germany [28].…”

Section: Key Findings On Oral Anticoagulants Appropriatenessmentioning

confidence: 99%

Appropriateness of Oral Anticoagulants for the Long-Term Treatment of Atrial Fibrillation in Older People: Results of an Evidence-Based Review and International Consensus Validation Process (OAC-FORTA 2016)

et al. 2017

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Importance: Age appropriateness of anticoagulants for stroke prevention in atrial fibrillation (AF) is uncertain.Objective: To review oral anticoagulants (OAC) for AF in older (age >65y) people, to classify appropriate and inappropriate drugs based on efficacy, safety and tolerability using the Fit-fOR-The-Aged (FORTA) classification.Evidence: We performed a structured comprehensive review of controlled clinical trials and summaries of individual product characteristics to assess study and total patient numbers, quality of major outcome data and data of geriatric relevance. The resulting evidence was discussed in a round table with an interdisciplinary panel of ten European experts. Decisions on age appropriateness were made using a Delphi process.Findings: For the 8 drugs included, 380 citations were identified. The primary outcome results were reported in 32 clinical trials with explicit and relevant data on older people. Though over 24000 patients aged >75/80 were studied for warfarin, data on geriatric syndromes were rare (2 studies reporting on frailty/falls/mental status), and missing for all other compounds. Apixaban was rated FORTA-A (highly beneficial). Other non-vitamin K antagonist OACs [NOACs] (including low/high-intensity dabigatran and high-intensity edoxaban) and warfarin were assigned to FORTA-B (beneficial). Phenprocoumon, acenocoumarol and fluindione were rated FORTA-C (questionable) mainly reflecting the absence of data. Conclusions: All NOACs and warfarin were classified as beneficial or very beneficial in older persons (FORTA-A or-B) underlining the overall positive assessment of the risk/benefit ratio for these drugs. For other vitamin-Kantagonists regionally used in Europe the lack of evidence should challenge current practice. KEY WORDSOlder people; Oral Anticoagulants; Atrial fibrillation; Effectiveness; Tolerability; FORTA Fit For The Aged. KEY POINTS Age appropriateness of chronically used anticoagulants to treat atrial fibrillation is still uncertain. Using a structured comprehensive approach including a literature search and subsequent Delphi process, an interdisciplinary expert group rated the appropriateness of oral anticoagulants for long-term treatment of atrial fibrillation in older people with regard to efficacy, tolerability, and safety. In older people the majority of these drugs, the non-vitamin K oral anticoagulants and warfarin, are seen to be beneficial or very beneficial while regionally used older vitamin K antagonists should be used with caution as evidence is missing. The evidence basis for the use of these drugs in older people regarding geriatric syndromes is very limited. 41.

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“…En los estudios en que el cuidado al anciano fue abordado, se enfatizó la práctica de cuidado relacionada con la terapéutica medicamentosa (25,26) .…”

Section: Líneas De Cuidado Y Solvencia Asistencialunclassified

“…Y cuando se realiza en la práctica geriátrica, predispone a mayores riesgos relacionados tanto con la práctica de multifármacos, como de aparición de efectos adversos. Estando el error de medicación caracterizado como un evento evitable, ocurrido por el uso del medicamento, que puede causar daño o no al paciente (19,(26)(27)(28)(29) . Se trata de un procedimiento rutinariamente realizado por la enfermería, exigiendo, para su práctica, de conocimiento científico y técnico que posibilite el desarrollo de prácticas seguras (12) .…”

Section: Líneas De Cuidado Y Solvencia Asistencialunclassified

Implicaciones de la seguridad del paciente en la práctica del cuidado de enfermería

Lima

Souza

Vasconcelos

et al. 2014

eglobal

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Nº 35 Julio 2014Página 293 REVISIONES Implicaciones de la seguridad del paciente en la práctica del cuidado de enfermeríaImplicações da segurança do paciente na prática do cuidado de enfermagem, Implications of patient safety in the practice of nursing care *Lima, Fabiane da Silva Severino *Souza, Natalia Pimentel Gomes **Freire RESUMENEl término seguridad viene siendo cada vez más discutido en el ámbito sanitario. Estando la Enfermería implicada en este proceso como promotora directa de acciones de seguridad por medio de sus prácticas de cuidado.Este trabajo tiene como objetivo investigar cómo el término seguridad viene siendo abordado en el escenario del cuidado de enfermería en el ámbito nacional e internacional.Investigación bibliográfica basada en artículos científicos publicados en revistas nacionales e internacionales indexadas en bases de datos Scientific Library (Scielo), Medical Literature Analysis and

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Dementia and Risk of Adverse Warfarin-Related Events in the Nursing Home Setting

Cited by 16 publications

References 25 publications

Use of Medications of Questionable Benefit in Advanced Dementia

Use of Medications of Questionable Benefit in Advanced Dementia

Appropriateness of Oral Anticoagulants for the Long-Term Treatment of Atrial Fibrillation in Older People: Results of an Evidence-Based Review and International Consensus Validation Process (OAC-FORTA 2016)

Implicaciones de la seguridad del paciente en la práctica del cuidado de enfermería

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