Quality of Anticoagulation Care in Patients Discharged from a Pharmacist‐Managed Anticoagulation Clinic After Stabilization of Warfarin Therapy

Garwood, Candice L.; Dumo, Peter; Baringhaus, Stephanie N; Laban, Kristyn M

doi:10.1592/phco.28.1.20

Cited by 36 publications

(54 citation statements)

References 15 publications

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“…Using patient self testing such as the CoaguChek offers a reliable alternative to laboratory determination of INR and is acceptable to the majority of suitably trained patients who previously attended a specialist anticoagulation clinic [9]. Point-of-care testing (POCT) coagulometers for measuring coagulation status in people receiving long-term vitamin K antagonist therapy allow both self-testing and self-management, defined as follows:…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of Point-of-Care Testing (POCT) in Reducing Total Waiting Time at Warfarin Clinic of a District Hospital: A Cohort Study

Kasinathan¹,

Pairan²,

Rowther³

et al. 2016

OALib

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Section: Discussionmentioning

confidence: 99%

“…Transition of patients from a pharmacist managed anticoagulation clinic back to a physician managed anticoagulation care after stabilization of warfarin therapy was associated with significant decrease in INR control and decreased patient satisfaction [9].…”

mentioning

confidence: 99%

Efficacy of Point-of-Care Testing (POCT) in Reducing Total Waiting Time at Warfarin Clinic of a District Hospital: A Cohort Study

Kasinathan¹,

Pairan²,

Rowther³

et al. 2016

OALib

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show abstract

“…Our study results were similar to those of Clark et al [26] whose study observed 1517 patients with in-range therapeutic INR levels, where approximately 32% of these patients had an out-of-range INR result during the 90 days following stabilization. Another study showed that 24% of patients who were stabilized on anticoagulation therapy had out-of-range INR measurements [27].…”

Section: Characteristics Of Patients With and Without International Nmentioning

confidence: 99%

Patterns of international normalized ratio values among new warfarin patients with nonvalvular atrial fibrillation

Nelson¹,

Milentijevic

Wang

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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Limited information exists regarding the relationship between international normalized ratio (INR) control/stability and the discontinuation of warfarin therapy among patients with nonvalvular atrial fibrillation (NVAF). This study evaluated the association between INR stabilization and warfarin discontinuation and assessed INR patterns before and after INR stabilization among patients (≥18 years) with NVAF who newly initiated warfarin (Veterans Health Administration datasets; October 1, 2007 through September 30, 2012). Achievement of INR stabilization (≥3 consecutive in-range therapeutic INR measurements ≥7 days apart) was examined from warfarin initiation through the end of warfarin exposure. Proportion of time in therapeutic range during warfarin exposure was calculated (Rosendaal method) and categorized as at least 60% or less than 60%. Among 34 346 patients, 49.4% achieved INR stabilization (mean time to stabilization, 98 days). Approximately 40% of INR values were out-of-range, even after achieving stabilization. During 30 days following an INR 4.0 or higher, patients had more INR testing than the overall mean (2.51 vs. 1.67 tests). Warfarin discontinuation was 4.2 times more likely among patients without INR stabilization versus those with INR stabilization (P < 0.00001). Patients with poor INR control (time in therapeutic range <60%) were 1.76 times more likely to discontinue warfarin within 1 year (P < 0.0001). INR stabilization is a better predictor of warfarin discontinuation than poor INR control. Improved approaches are necessary to maintain appropriate anticoagulation levels among patients with NVAF.

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“…2,8,9,13,15,21 For HIV patients diagnosed with VTE, warfarin anticoagulation (WAC) with serial monitoring of international normalized ratios (INR) to gauge the effectiveness of anticoagulation is the standard of therapy. [23][24][25] Due to variable dose response associated with drug interactions, diet, and other comorbid conditions, providers must monitor INR values frequently and adjust WAC dosing as needed to consistently maintain the recommended therapeutic window. 3,23,[25][26][27][28] There is great variability in how each provider adjusts warfarin dosage, which affects overall treatment outcomes.…”

Section: Introductionmentioning

confidence: 99%

Venous thromboembolism among HIV-positive patients and anticoagulation clinic outcomes integrated within the HIV primary care setting

Modi

McGwin

Westfall³

et al. 2014

Int J STD AIDS

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The purpose of this study was to explore factors associated with venous thromboembolism (VTE) among a cohort of HIV-infected patients and to describe early outcomes of warfarin anticoagulation therapy treated in a pharmacist-based anticoagulation clinic (ACC). A nested case-control study was conducted using the University of Alabama at Birmingham 1917 HIV Clinic Cohort. Conditional logistic regression was used to estimate factors associated with VTE. Among HIV-infected VTE cases, ACC-managed patients were compared to primary care provider (PCP)-managed patients to determine Time within Therapeutic INR Range (TTR). CD4 < 200 cells/µl (OR = 4.50; 95% CI = 1.52, 13.37; p = 0.007) and prior surgical procedures (13.20; 1.56; 111.4; p = 0.018) demonstrated positive associations with VTE, whereas longer HIV duration demonstrated a negative association (0.87; 0.78, 0.98; p = 0.019). TTR was 56.2% among ACC-managed patients compared to 30.5% of PCP-managed patients (p = 0.174). Overall, prior surgical procedures and low CD4 count were associated with an increased risk of VTE among HIV-infected patients. Despite small sample size, patients managed in ACC tend to achieve greater proportion of TTR compared to those managed by PCPs, suggesting that this model of therapy may provide additional benefits to HIV-infected patients.

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Quality of Anticoagulation Care in Patients Discharged from a Pharmacist‐Managed Anticoagulation Clinic After Stabilization of Warfarin Therapy

Cited by 36 publications

References 15 publications

Efficacy of Point-of-Care Testing (POCT) in Reducing Total Waiting Time at Warfarin Clinic of a District Hospital: A Cohort Study

Efficacy of Point-of-Care Testing (POCT) in Reducing Total Waiting Time at Warfarin Clinic of a District Hospital: A Cohort Study

Patterns of international normalized ratio values among new warfarin patients with nonvalvular atrial fibrillation

Venous thromboembolism among HIV-positive patients and anticoagulation clinic outcomes integrated within the HIV primary care setting

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