Factors influencing physicians' reported use of anticoagulation therapy in nonvalvular atrial fibrillation: A cross-sectional survey

Gross, Cary P.; Vogel, Eric W.; Dhond, Abhay J.; Marple, Cheryl Beadle; Edwards, Roger; Hauch, Ole; Demers, Elizabeth; Ezekowitz, Michael D.

doi:10.1016/s0149-2918(03)80167-4

Cited by 99 publications

(79 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The response rate was rather low in many of the studies, although not lower than in similar studies using vignettes [14,15], whereas in some studies it is rather high and less prone to selection bias. In Norway participating GPs were representative for Norwegian GPs regarding sex and age distribution (statistics on file with the Norwegian Medical Association).…”

Section: Discussionmentioning

confidence: 64%

Analytical performance specifications based on how clinicians use laboratory tests. Experiences from a post-analytical external quality assessment programme

Thue

Sandberg²

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

View full text Add to dashboard Cite

Analytical performance specifications can be based on three different models: the effect of analytical performance on clinical outcome, based on components of biological variation of the measurand or based on stateof-the-art. Models 1 and 3 may to some degree be combined by using case histories presented to a large number of clinicians. The Norwegian Quality Improvement of Primary Care Laboratories (Noklus) has integrated vignettes in its external quality assessment programme since 1991, focusing on typical clinical situations in primary care. Haemoglobin, erythrocyte sedimentation rate (ESR), HbA 1c , glucose, u-albumin, creatinine/estimated glomerular filtration rate (eGFR), and Internationl Normalised Ratio (INR) have been evaluated focusing on critical differences in test results, i.e., a change from a previous result that will generate an "action" such as a change in treatment or follow-up of the patient. These critical differences, stated by physicians, can translate into reference change values (RCVs) and assumed analytical performance can be calculated. In general, assessments of RCVs and therefore performance specifications vary both within and between groups of doctors, but with no or minor differences regarding specialisation, age or sex of the general practitioner. In some instances state-of-the-art analytical performance could not meet clinical demands using 95% confidence, whereas clinical demands were met using 80% confidence in nearly all instances. RCVs from vignettes should probably not be used on their own as a basis for setting analytical performance specifications, since clinicians seem "uninformed" regarding important principles. They could rather be used as a background for focus groups of "informed" physicians in discussions of performance specifications tailored to "typical" clinical situations.

show abstract

Section: Discussionmentioning

confidence: 64%

Analytical performance specifications based on how clinicians use laboratory tests. Experiences from a post-analytical external quality assessment programme

Thue

Sandberg²

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

View full text Add to dashboard Cite

show abstract

“…It has been shown that health care providers overestimate the risk of ICH by 10 times when compared with the actual risk. 17 Although there is little good evidence that quantifies the degree to which "fall risk" or a "history of falls" increases the risk of serious ICH, the ICH rate per 100 patient-years among patients at a high risk for falls is 2.8%, whereas the ischemic stroke rate per 100 patient-years in the same population is 13.7%. 18 Thus, the use of anticoagulant therapy in patients with AF does not appear to be mainly driven by perceived benefits.…”

Section: Discussionmentioning

confidence: 99%

Intracranial hemorrhage in patients with atrial fibrillation receiving anticoagulation therapy

Lopes

Guimarães

Kolls

et al. 2017

Blood

View full text Add to dashboard Cite

Key Points• Nearly 80% of the warfarintreated patients with ICH had an INR within or below therapeutic range around 2 weeks before the event.• We can reduce ICH by using apixaban rather than warfarin and by avoiding concomitant aspirin, especially in patients with older age.We investigated the frequency and characteristics of intracranial hemorrhage (ICH), the factors associated with the risk of ICH, and outcomes post-ICH overall and by randomized treatment. We identified patients with ICH from the overall trial population enrolled in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial who received ‡1 dose of the study drug (n 5 18 140). ICH was adjudicated by a central committee. Cox regression models were used to identify factors associated with ICH. ICH occurred in 174 patients; most ICH events were spontaneous (71.7%) versus traumatic (28.3%). Apixaban resulted in significantly less ICH (0.33% per year), regardless of type and location, than warfarin (0.80% per year). Independent factors associated with increased risk of ICH were enrollment in Asia or Latin America, older age, prior stroke/transient ischemic attack, and aspirin use at baseline. Among warfarin-treated patients, the median (25th, 75th percentiles) time from most recent international normalized ratio (INR) to ICH was 13 days (6, 21 days). Median INR prior to ICH was 2.6 (2.1, 3.0); 78.5% of patients had a pre-ICH INR <3.0. After ICH, the modified Rankin scale score at discharge was ‡4 in 55.7% of patients, and the overall mortality rate at 30 days was 43.3% with no difference between apixaban-and warfarin-treated patients. ICH occurred at a rate of 0.80% per year with warfarin regardless of INR control and at a rate of 0.33% per year with apixaban and was associated with high short-term morbidity and mortality. This highlights the clinical relevance of reducing ICH by using apixaban rather than warfarin and avoiding concomitant aspirin, especially in patients of older age. This trial was registered at www.clinicaltrials.gov as

show abstract

“…6,7 This could be partly attributable to an overestimated risk of hemorrhage associated with oral anticoagulant use. Van Walraven et al 6 Tangelder et al 34 Poli et al 33 Cheung et al 29 EAFT 36 Yasaka et al 27 Torn et al 35 Chimowitz et al 32 Hutten et al 25 Azar et al 39 Hylek et al a survey conducted by Gross and colleagues 41 showed that physicians' estimates of annual rates of intracranial hemorrhage associated with the use of warfarin were more than 10 times higher than those based on the literature. 41 When both hemorrhagic and thromboembolic events are considered, our data showed that patients were safer with a ratio slightly above, rather than below, the therapeutic range of 2-3.…”

Section: Discussionmentioning

confidence: 99%

Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis

Oake¹,

Jennings²,

Forster³

et al. 2008

Canadian Medical Association Journal

148

124

View full text Add to dashboard Cite

O ral anticoagulant therapy is essential for the treatment and prevention of many thromboembolic disorders. Since anticoagulants can cause serious adverse events, 1-3 physicians monitor the international normalized ratios of patients taking these drugs to ensure that their ratios fall within a target range.An international normalized ratio of 2-3 is the most common target range. Results of previous studies revealed an increased risk of bleeding among patients whose ratios exceeded 4, an increased risk of stroke among patients whose ratios were 1.5-2 and a decreased risk of stroke at a ratio of 2.4. 4,5 However, the evidence supporting the range of 2-3 has some deficiencies. We sought to determine whether the risk of hemorrhagic and thromboembolic events is minimized at an international normalized ratio of 2-3 among patients taking anticoagulants. In addition, it has been observed that patients spend more time with a ratio below 2 than above 3.6,7 The impact of such systematic underanticoagulation on patient outcomes is unknown. We sought to determine the effect of under-or overanticoagulation on the risk of thromboemboli and hemorrhage. Methods Data sourcesWe searched MEDLINE (1966MEDLINE ( -2006 for potentially pertinent studies. We then modified our strategy to include EMBASE (1980EMBASE ( -2006, the Cochrane Central Register of Controlled Trials (1980Trials ( -2006 and CINAHL (1982CINAHL ( -2006 databases. We manually searched references in the Science Citation Index. Our search strategy is outlined in Appendix 1 (available at www.cmaj.ca/cgi/content/full/179/3/235/DC2). Study selection

show abstract

Factors influencing physicians' reported use of anticoagulation therapy in nonvalvular atrial fibrillation: A cross-sectional survey

Cited by 99 publications

References 40 publications

Analytical performance specifications based on how clinicians use laboratory tests. Experiences from a post-analytical external quality assessment programme

Analytical performance specifications based on how clinicians use laboratory tests. Experiences from a post-analytical external quality assessment programme

Intracranial hemorrhage in patients with atrial fibrillation receiving anticoagulation therapy

Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis

Contact Info

Product

Resources

About