Patient Education on Oral Anticoagulation

Hawes, Emily M.

doi:10.3390/pharmacy6020034

Cited by 16 publications

(18 citation statements)

References 33 publications

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“…In clinical practice, it is desirable to start anticoagulation as soon as possible after the event because the risk of recurrence is highest in the acute phase [7,8]. Moreover, adherence is better if prevention is started in inpatients shortly after the event [9,10].…”

Section: Introductionmentioning

confidence: 99%

Early initiation of direct anticoagulation after stroke in patients with atrial fibrillation

D’Anna

Filippidis

Antony

et al. 2020

Euro J of Neurology

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Background and purpose: The safety of early initiation of anticoagulant therapy in patients with ischaemic stroke related to atrial fibrillation (AF) is unknown. We investigated the safety of early initiation of direct oral anticoagulants (DOACs), vitamin K antagonists (VKAs) or no anticoagulation. Methods: This observational, retrospective, single-centre study included consecutive patients with recent (<4 weeks) ischaemic stroke and AF. The primary outcome was the rate of major (intracranial and extracranial) bleeding in patients on different treatment schemes, i.e. DOACs, VKAs and not anticoagulated. We also investigated the rate of ischaemic cerebrovascular events and mortality. Results: We included 959 consecutive patients with AF and ischaemic stroke followed up for an average of 16.1 days after the index event. A total of 559 out of 959 patients (58.3%) were anticoagulated with either VKAs (n = 259) or DOACs (n = 300). Anticoagulation was started after a mean of 7 AE 9.4 days in the DOAC group and 11.9 AE 19.7 days in the VKA group. Early initiation of any anticoagulant was not associated with an increased risk of any major bleeding [odds ratio (OR), 0.49; 95% confidence intervals (CI), 0.21-1.16] and in particular of intracranial bleeding (OR, 0.47; 95% CI, 0.17-1.29; P = 0.143) compared with no anticoagulation. In contrast to VKAs (OR, 0.78; 95% CI, 0.28-2.13), treatment with DOACs (OR, 0.32; 95% CI, 0.10-0.96) reduced the rate of major bleeding compared with no anticoagulation. Early recurrences of ischaemic stroke did not differ significantly among the three groups. Conclusions: Starting DOACs within a mean of 7 days after stroke appeared to be safe. Randomized controlled studies are needed to establish the added efficacy of starting anticoagulation early after stroke.

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Section: Introductionmentioning

confidence: 99%

Early initiation of direct anticoagulation after stroke in patients with atrial fibrillation

D’Anna

Filippidis

Antony

et al. 2020

Euro J of Neurology

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“…Patient education and improved understanding of their anticoagulant therapy has been shown to improve patient safety and help avoid preventable anticoagulant related adverse effects [ 5 , 6 ]. The National Patient Safety Agency in England (now NHS Improvement) issued a patient safety alert with actions to improve anticoagulant safety, which included providing specific patient information, regular blood monitoring and checking drug interactions and subsequently updated this to include DOACs and advised that patients on anticoagulant therapy should always carry a standard yellow (credit card sized) alert card to inform health and social care practitioners that they are taking an anticoagulant.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of patients’ knowledge about oral anticoagulant medicines and use of alert cards by community pharmacists

Jani

Hirani

Livingstone³

2020

Int J Clin Pharm

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Background Anticoagulants continue to pose high risk of harm to patients despite the discovery of novel direct-acting oral anticoagulant agents that require less monitoring than warfarin. Objective To evaluate patients’ knowledge about their oral anticoagulants and the potential role for community pharmacists in optimising safety. Setting Community pharmacies in England. Methods An online survey-based evaluation conducted over a 5-month period to ascertain patients’ knowledge, use of anticoagulant alert cards, compliance with national monitoring requirements for warfarin, and frequency and nature of community pharmacist involvement in optimisation. Differences between patients on direct-acting oral anticoagulant agents and warfarin were assessed using Chi squared tests. Main outcome measure Patients’ knowledge and use of anticoagulant alert cards. Results A total of 1515 pharmacies participated. Of 22,624 patients, 97% knew that they were taking anticoagulants; 20% had alert cards with them at time of dispensing; 17% had no card and 10% refuted their usefulness. Patients on warfarin were more aware of interactions with over-the-counter or herbal medicines than those on direct-acting oral anticoagulant agents. Of the patients on warfarin, 82% confirmed monitoring in the previous 12 weeks in accordance with national standards, with the international normalised ratio value known for 76%. Pharmacists intervened in a fifth of the patients to issue an alert card, contact the general practitioner for a change in the prescription or due to interacting medicines. Conclusion Patients had reasonable knowledge of their anticoagulation therapy, but areas for improvement were identified. Community pharmacists are well placed to optimise the safe use of anticoagulants.

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“…Although hospitalization should be avoided whenever possible, it can also be a crucial contact point with the health care system to assess and enhance medication adherence through patient education and counseling. 5 The objectives of this study were (1) to evaluate OAC adherence before and after a hospitalization, stratified by the reason for admission, and (2) to determine whether OAC choice is associated with changes in OAC adherence after a hospitalization. The study hypotheses were that OAC adherence would only decline after admission for bleeding as well as among individuals switching from warfarin to DOACs at discharge as a result of greater out-of-pocket cost burden.…”

mentioning

confidence: 99%

“…There is limited information on whether OAC choice (DOAC vs. warfarin) affects adherence, particularly after an unplanned hospitalization. Although hospitalization should be avoided whenever possible, it can also be a crucial contact point with the health care system to assess and enhance medication adherence through patient education and counseling 5 …”

mentioning

confidence: 99%

Impact of Hospitalization and Medication Switching on Post‐discharge Adherence to Oral Anticoagulants in Patients With Atrial Fibrillation

et al. 2020

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BACKGROUND Adherence to chronic medications remains poor in practice. There is limited evidence on how hospitalization affects post-discharge adherence to oral anticoagulants (OACs) in individuals with atrial fibrillation. The aim of this study was to examine the impact of hospitalization and medication switching on post-discharge adherence to OACs in the population with atrial fibrillation. METHODS A quasi-experimental pre-post observational study was conducted using United States commercial insurance health care claims from the 2009 to 2016 Optum database. Adults with atrial fibrillation taking OACs who had a random hospitalization occurring after the first observed OAC prescription fill and no other admission in the preceding and following 6 months were identified. OAC adherence was estimated by the proportion of days covered within 6 and 12 months before and after hospitalization. Difference-indifference analysis was employed to compare the pre-hospitalization and post-hospitalization proportion of days covered, stratified by reasons for hospitalization (i.e., bleeding vs non-bleeding-related reasons) and adjusting for imbalanced baseline characteristics between groups. Change in adherence when the OAC was switched at discharge was also examined. RESULTS The 22,429 individuals who met study criteria were predominantly male (52.4%), white (77.2%), and older age (median 74 years). A clinically significant hemorrhage was the reason for 1029 (4.5%) of qualifying hospitalizations. After covariate adjustment, there was a reduction in the Conflict of interest: Dr. Leonard serves on the executive committee of and Dr. Hennessy directs the University of Pennsylvania's Center for Pharmacoepidemiology Research and Training. The center receives unrestricted educational funding from Pfizer and Sanofi. Dr. Hennessy also consulted for Janssen Research & Development LLC, Daiichi Sankyo Inc, and Mallinckrodt Pharmaceutical and receives salary support from a sponsored research agreement between Pfizer Inc. and the University of Pennsylvania, all unrelated to the topic of this paper. All other authors declared no competing interests for this work.

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Patient Education on Oral Anticoagulation

Cited by 16 publications

References 33 publications

Early initiation of direct anticoagulation after stroke in patients with atrial fibrillation

Early initiation of direct anticoagulation after stroke in patients with atrial fibrillation

Evaluation of patients’ knowledge about oral anticoagulant medicines and use of alert cards by community pharmacists

Impact of Hospitalization and Medication Switching on Post‐discharge Adherence to Oral Anticoagulants in Patients With Atrial Fibrillation

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