Introduction of Point-of-Care Testing in Japanese Outpatient Clinics Is Associated With Improvement in Time in Therapeutic Range in Anticoagulant-Treated Patients

Okuyama, Yuji; Matsuo, Motoaki; Matsuo, Hiroshi; Sakaguchi, Yoshihide; Takai, Hiroyuki; Horiguchi, Y; Ryomoto, Teruhiko; Adachi, Seiji; Amano, Toshio; Togawa, Masaki; Masuda, Masaharu; Minamiguchi, Hitoshi; Nanto, Shinsuke; Komuro, Issei; Sakata, Yasushi

doi:10.1253/circj.cj-13-1256

Cited by 20 publications

(17 citation statements)

References 31 publications

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“…Frequent, even weekly, dose adjustments for the majority of INRs out of range is a simple concept that is associated with improved TTR and clinical outcome [27]. Systems that implement algorithm based dosing for AF patients on warfarin or widespread use of point of care testing devices for the measurement of INR may improve the management of patients [27][28][29]. If good anticoagulation control cannot be achieved with warfarin, new oral anticoagulants are inevitable strategies in patients with NVAF.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the impact of warfarin time in therapeutic range on outcomes of patients with atrial fibrillation in Turkey: Perspectives from the observational, prospective WATER Registry

et al. 2015

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Background: Warfarin is highly efficacious in reducing stroke risk in patients with atrial fibrillation (AF). However, its safety and efficacy in stroke prevention is markedly influenced by its time in therapeutic range (TTR (40.3 ± 18 vs. 46.9 ± 19, respectively, p < 0.001). Death, cardiac hospitalization and minor bleeding rates were higher in the group with TTR value < 40% than the group with > 40% (3.4% vs. 5.9%; 28.6% vs. 35.4%; 36.5% vs. 41.7%, respectively, all of them p < 0.001). A correlation analysis showed a negative correlation between age and TTR value (r = -0.178, p < 0.001 non-valvular AF patients. (Cardiol J 2015; 22, 5: 567-575)

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Section: Discussionmentioning

confidence: 99%

Evaluation of the impact of warfarin time in therapeutic range on outcomes of patients with atrial fibrillation in Turkey: Perspectives from the observational, prospective WATER Registry

et al. 2015

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“…It is not clear whether non-concordance is due to lack of understanding by the patient, poor communication by healthcare professionals or lack of access to anticoagulative medications and monitoring facilities 19. An encouraging study from Japan showed that point-of-care testing improves INR measurements,20 though whether this intervention is applicable to LMIC populations is uncertain.…”

Section: Global Health Problem Analysismentioning

confidence: 99%

Rheumatic fever with severe carditis: still prevalent in the South West Pacific

et al. 2017

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Rheumatic heart disease (RHD) has a worldwide prevalence of 33 million cases and 270 000 deaths annually, making it the most common acquired heart disease in the world. There is a disparate global burden in developing countries. This case report aims to address the minimal RHD coverage by the international medical community. A Tahitian boy aged 10 years was diagnosed with advanced heart failure secondary to RHD at a local clinic. Previous, subtle symptoms of changes in handwriting and months of fever had gone unrecognised. Following a rapid referral to the nearest tertiary centre in New Zealand, urgent cardiac surgery took place. He returned home facing lifelong anticoagulation. This case highlights the RHD burden in Oceania, the limited access to paediatric cardiac services in countries where the RHD burden is greatest and the need for improved awareness of RHD by healthcare professionals, and the general public, in endemic areas.

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“…For instance, the point-of-care testing in GP practices is an important feature that is known to influence TTR [90,91]. It will be a task of future research to examine this hypothesis with adequate methods.…”

Section: Strength and Limitationsmentioning

confidence: 99%

Anticoagulation Control in Swiss Primary Care: Time in Therapeutic Range Percentages Exceed Benchmarks of Phase III Trials

Djalali

Valeri

Gerber

et al. 2016

Clin Appl Thromb Hemost

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BACKGROUND: In randomized controlled trials, non-vitamin K antagonist oral anticoagulants (NOACs) demonstrated noninferiority to vitamin K antagonists (VKAs) in patients who spent limited time in therapeutic range (TTR). In real-life patients, TTR is known to vary significantly across countries and health-care settings. OBJECTIVE: We aim to evaluate the quality of VKA treatment in Swiss primary care (PC) by comparing patients' median TTR to levels achieved in the phase III NOAC trials RE-LY, ROCKET-AF, ARISTOTLE, and ENGAGE-AF-TIMI 48. Patient characteristics affecting TTR control shall be estimated. METHODS: This is a retrospective longitudinal study in Swiss PC patients receiving VKA for 6 months. We identified patients from the PC research database FIRE (Family medicine International Classification of Primary Care Research using Electronic medical records) and calculated TTR according to Rosendaal formula. Comparative data from NOAC trials were retrieved from medical literature. Linear regression models were used to assess predictors of TTR. RESULTS: Primary care encounters of 215 patients were analyzed. Like in the NOAC trials, median observation period was 2.2 years, but patients were older (67.9% vs 38% 75 years) and differed in terms of concomitant diseases and drugs. Median TTR was 75% (65% in the NOAC trials). Female sex was independently associated with a lower TTR and significantly modified by increasing age. CONCLUSION: Practitioners should consider that patients in NOAC trials are only partly representative of PC patients, particularly in terms of TTR control. Only a minority of the observed patients would require a therapy switch to NOACs due to inadequate TTR. Further research is needed in order to identify specific features of care management that are associated with these outcomes.

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Introduction of Point-of-Care Testing in Japanese Outpatient Clinics Is Associated With Improvement in Time in Therapeutic Range in Anticoagulant-Treated Patients

Cited by 20 publications

References 31 publications

Evaluation of the impact of warfarin time in therapeutic range on outcomes of patients with atrial fibrillation in Turkey: Perspectives from the observational, prospective WATER Registry

Evaluation of the impact of warfarin time in therapeutic range on outcomes of patients with atrial fibrillation in Turkey: Perspectives from the observational, prospective WATER Registry

Rheumatic fever with severe carditis: still prevalent in the South West Pacific

Anticoagulation Control in Swiss Primary Care: Time in Therapeutic Range Percentages Exceed Benchmarks of Phase III Trials

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