Guideline adherence for antithrombotic therapy in acute coronary syndrome: an overview in Dutch hospitals

Kikkert, Wouter J.; Piek, Jan J.; Winter, Robbert J. de; Peters, Ron J.G.; Henriques, José P.S.

doi:10.1007/bf03091779

Cited by 6 publications

(4 citation statements)

References 31 publications

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“…however, in the actual guidelines of the ESMO concerning BTC,thistherapeuticregimewasapproved [3].Inoursurvey, abouthalfoftherespondentsstatedtousethecombinationof gemcitabineandcisplatinasfirst-linechemotherapy,butthe remainingrespondentsdeclaredtoapplyotherregimes.Considering that the participants were physicians interested in BTC,itseemsquestionablewhythenewtherapeuticstandard isnotadoptedtoagreaterextent.SimilarresultswerepublishedrecentlyforDutchhospitalswheretheguidelineadherenceforantithrombotictherapyinacutecoronarysyndrome was quite diverse [6]. Few data are available on how guidelinesaretransferredingeneralandifcompliancewithguidelinesledtobettertreatmentresults.AGermansurveyanalyzing the physicians' knowledge and their compliance with guidelinesforcardiovasculardiseasesrevealedthatphysicians who adequately knew the guidelines performed essentially notdifferentlyfromthosewhodidnot [7].Forbreastcancer, however, recent data suggest a better outcome for patients with guideline-conforming treatment.…”

supporting

confidence: 55%

Biliary Tract Cancer: A Survey Regarding the Current Oncological Daily Care Practice in Germany

Sinn

Bischoff²,

Nehls³

et al. 2012

Onkologie

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Background: The low incidence and the variable presentation complicate clinical investigations on biliary tract cancer. The results of Valle et al. in 2009 provided, for the first time, an evidence-based palliative treatment for this rare tumor type. So far no data are available in Germany regarding the current daily care practice. Methods: We started this national survey in May 2011, including about 3,400 members of the AIO (Working Group Medical Oncology), DGHO (German Society of Hematology and Oncology) and GGHBB (Society of Gastroenterology and Hepatology in Berlin and Brandenburg). The standardized online form contained questions concerning field of action and diagnostic and therapeutic procedures. Evaluation was conducted anonymously. Results: 162 responses could be obtained, corresponding to a response rate of about 5%. 70.4% of the respondents were physicians in hospitals, 23.5% stated to work in private practices. 61.7% of the respondents were medical oncologists and 27.2% gastroenterologists. 52.5% of the participants pointed out to use the standard regimen of gemcitabine and cisplatin. For second-line regimen, the most frequent answer (29%) specified the administration of oxaliplatin in combination with 5-fluorouracil (5-FU) or capecitabine. Conclusions: This survey may help to clarify the current oncologic daily care procedures for patients with biliary tract cancer in Germany. The results can be helpful for further clinical investigations or the implementation of a tumor-specific register.

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supporting

confidence: 55%

Biliary Tract Cancer: A Survey Regarding the Current Oncological Daily Care Practice in Germany

Sinn

Bischoff²,

Nehls³

et al. 2012

Onkologie

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“…The authors have concluded that an additional benefit may be achieved by the routine dose adjustment of LMWH for patients with renal insufficiency and aged over 75 years, since these patients are at high risk of bleeding complications secondary to antithrombotic treatment. 28 The contraindications; patients to whom heparins are prescribed for a long-term treatment; and patients with concomitant use of antithrombotic medicines, NSAIDs, and warfarin due to increased risk of ADRs. Low-molecular-weight heparins did not differ in terms of their safety parameters; therefore, the requirement for additional follow-up was not affected by the heparin brand or name prescribed for each patient.…”

Section: ■■ Conclusionmentioning

confidence: 99%

Influence of Coadministration of Antithrombotic Medicines, Warfarin, and NSAIDs on Heparin Safety: Data from a Prospective Observational Study

Pranckeviciene¹,

Kaduševičius²,

Putniene³

2013

JMCP

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“…The European Society of Cardiology (ESC), American Heart Association (AHA) and American College of Cardiology (ACC) currently recommend the use of unfractionated heparin (UFH),enoxaparin or bivalirudin in STEMI patients undergoing PPCI [ 3 , 4 ]. Of these 3 agents, UFH is currently the most commonly used anticoagulant for this indication [ 5 , 6 ]. UFH was recently shown to be associated with lower rates of thrombotic events and similar bleeding events as compared to bivalirudin in a large scale all-comer randomized controlled trial reflecting contemporary practice (i.e.…”

Section: Introductionmentioning

confidence: 99%

Influence of chronic kidney disease on anticoagulation levels and bleeding after primary percutaneous coronary intervention in patients treated with unfractionated heparin

Kikkert

Brussel

Damman

et al. 2015

J Thromb Thrombolysis

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Unfractionated heparin (UFH) plasma protein binding and elimination might be impaired in patients with chronic kidney disease (CKD—defined as creatinine clearance <60 ml/min). It is currently unknown at which UFH bolus dose persistent prolongation of activated partial thromboplastin time (aPTT) occurs in ST-segment elevation myocardial infarction (STEMI) patients with CKD. We investigated the effect of different UFH bolus doses on the first aPTT measured within 6 and 12 h after PPCI in 1071 STEMI patients with and without CKD undergoing primary percutaneous coronary intervention (PPCI) between 1-1-2003 and 31-07-2008. In the first 6 h after PPCI, aPTT ratio was 5.1 for patients with CKD versus 3.4 for those without (p < 0.001). The proportion of patients with markedly high aPTTs (aPTT ratio ≥ 4 times control) increased with increasing heparin bolus and beyond 130 IU/kg there was a marked difference between patients with and without CKD (74.1 and 42.3 % respectively, p < 0.001). By multivariable analysis, CKD was associated with an increased risk of markedly high aPTTs (odds ratio (OR) 2.04; 95 % confidence interval (CI) 1.27–3.27), driven largely by an increased risk of aPTT prolongation in patients treated with UFH boluses ≥130 IU/kg (OR 3.69; 95 % CI 1.85–7.36; p for interaction = 0.009). In conclusion, CKD is associated with severe persistent aPTT prolongation in STEMI patients undergoing PPCI, possibly due to impaired plasma protein binding and reduced UFH elimination. A lower heparin bolus dose might result in lower aPTTs and less bleeding complications in patients with CKD undergoing PPCI.Electronic supplementary materialThe online version of this article (doi:10.1007/s11239-015-1255-x) contains supplementary material, which is available to authorized users.

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Guideline adherence for antithrombotic therapy in acute coronary syndrome: an overview in Dutch hospitals

Cited by 6 publications

References 31 publications

Biliary Tract Cancer: A Survey Regarding the Current Oncological Daily Care Practice in Germany

Biliary Tract Cancer: A Survey Regarding the Current Oncological Daily Care Practice in Germany

Influence of Coadministration of Antithrombotic Medicines, Warfarin, and NSAIDs on Heparin Safety: Data from a Prospective Observational Study

Influence of chronic kidney disease on anticoagulation levels and bleeding after primary percutaneous coronary intervention in patients treated with unfractionated heparin

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