Self-managed oral anticoagulant therapy: a call for implementation

Christensen, Thomas; Grove, Erik Lerkevang; Nielsen, Peter Brønnum; Larsen, Torben Bjerregaard

doi:10.1586/14779072.2016.1140573

Cited by 11 publications

(15 citation statements)

References 19 publications

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“…[6] It seems that an educational program could assist patients to improve their knowledge level on oral anticoagulants and to achieve adequate self-care management, including effective therapy adherence, better control of INR, symptom monitoring, recognition and evaluation. In line with the results of our study, Christensen et al [3] in their prospective multi-centre study of 615 patients with surgical heart valve replacement, concluded that those with adequate education and effective management of their anticoagulant therapy are low-risk patients for hemorrhage episodes, postoperatively. Likewise, White and his colleagues [7] in an extensive series of heart valve replacement patients stated that patients with high knowledge level on anticoagulants management, due to their participation in an educational program, had a significantly lower incidence of hemorrhagic episodes during their rehabilitation.…”

Section: Discussionsupporting

confidence: 89%

“…[1] As highlighted by many studies patient education on oral anticoagulant therapy is an effective option for reducing the occurrence of complications after heart valve replacement surgery. [2,3] However, other studies [4,5] failed to document this relationship, and the evidence of this effectiveness remains inconclusive. Additionally, the effect of a nurse-led patient education on the effective oral anticoagulant therapy management among heart valve replacement patients has little been studied worldwide.…”

Section: Introductionmentioning

confidence: 99%

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The effect of a nurse-led patient education program for oral anticoagulant therapy on the incidence of thromboembolic and hemorrhagic episodes after surgical heart valve replacement

Eltheni¹,

Giakoumidakis²,

Brokalaki³

et al. 2017

IJSM

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Introduction: Although, the effects of patient education on the effective anticoagulant management, among patients undergoing heart valve replacement with a mechanical prosthesis, have been reported, the evidence of this association remains inconclusive. Aim: To investigate the effect of a nurse-led patient education program for oral anticoagulant therapy on the incidence of thromboembolic and hemorrhagic episodes after surgical heart valve replacement. Methods: A quasi-experimental study was conducted. Patients were allocated to a) a control group (n=100), including those who received the usual education on oral anticoagulants, and b) an intervention group (n=100), with those who attended a nurse-led education program, postoperatively, including verbal courses and written material through an education booklet. We investigated the incidence of hemorrhagic and thromboembolic episodes three months after patients' hospital discharge. Patients' socio-demographic and clinical characteristics were obtained using a structured short questionnaire and through the medical and nursing patient records review. Patients' follow-up data were collected via phone interviews. Results: The baseline characteristics were similar for both groups. Patients who received nurse-led education on oral anticoagulant therapy had a significantly lower 3-month incidence of hemorrhagic episodes compared with controls (1% vs. 14%, p<0.001). However, we found insignificant differences in the 3-month incidence of thromboembolic events between the two groups. Conclusion: The implementation of a nurse-led education program on oral anticoagulants management failed to show effectiveness on the 3-month incidence of thromboembolic episodes. However, this educational intervention seems to be superior to the general patient education, leading to the significantly lower occurrence of hemorrhagic episodes.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

The effect of a nurse-led patient education program for oral anticoagulant therapy on the incidence of thromboembolic and hemorrhagic episodes after surgical heart valve replacement

Eltheni¹,

Giakoumidakis²,

Brokalaki³

et al. 2017

IJSM

View full text Add to dashboard Cite

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“…PSM is regarded as an important concept to meet the needs of patients with chronic disorders such as diabetes, hypertension or chronic obstructive pulmonary disease (Bodenheimer et al, 2002;Effing et al, 2007;Uhlig et al, 2013). There are several reasons why PSM should be implemented in the long-term treatment with VKA (Christensen et al, 2016). There are several reasons why PSM should be implemented in the long-term treatment with VKA (Christensen et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…It is not only effective in terms of clinical outcomes but reduces health care costs in patients with arthritis, asthma and other conditions (Bodenheimer et al, 2002). There are several reasons why PSM should be implemented in the long-term treatment with VKA (Christensen et al, 2016). First, a large number of patients worldwide are treated with anticoagulants and the numbers are expected to increase [1% of the population was estimated for the UK by Pirmohamed (2006)].…”

Section: Discussionmentioning

confidence: 99%

Predictors of anticoagulation quality in 15 834 patients performing patient self‐management of oral anticoagulation with vitamin K antagonists in real‐life practice: a survey of the International Self‐Monitoring Association of Orally Anticoagulated Patients

et al. 2016

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Although patient self-management (PSM) of oral anticoagulation with vitamin K antagonists is recommended for patients requiring long-term anticoagulation, important aspects are still unclear. Using data from a large international survey (n = 15 834; median age 72 years; 30·1% female), we studied predictors of poor anticoagulation control (percentage of International Normalized Ratio values within therapeutic range below 75%) and developed a simple prediction model. The following variables were identified as risk factors for poor anticoagulation control and included in the final model: higher intensity of therapeutic range (odds ratio [OR] on every level 1·9; 95% confidence interval [CI] 1·8-2·0), long intervals between measurements (>14 d; 1·5; 95% CI 1·3-1·7), female sex (OR 1·3; 95% CI 1·2-1·4), and management other than PSM (OR 1·4; 95% CI 1·2-1·6). At a threshold of 0·2 (at least one variable present), the model predicted poor anticoagulation control with a sensitivity of 85·3% (95% CI: 84·0, 86·4) and a specificity of 28·5% (27·6, 29·5). The area under the receiver operated characteristic curve was 0·65. Using the proposed prediction model, physicians will be able to identify patients with a low chance of performing well, considering additional training, regular follow-up, or adjustment of therapeutic ranges.

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“…In Denmark, warfarin therapy is managed at hospital-based outpatient anticoagulation clinics, by general practitioners, and by patients trained to manage their own warfarin therapy (i.e., patient self-management). 25 Warfarin initiation and titration is always handled by a physician or a trained nurse. Danish guidelines recommend an initiation dose of 5 mg once daily in most patients.…”

Section: Settingmentioning

confidence: 99%

Ischemic Stroke and Systemic Embolism in Warfarin Users With Atrial Fibrillation or Heart Valve Replacement Exposed to Dicloxacillin or Flucloxacillin

Hellfritzsch

Lund

Ennis

et al. 2019

Clin Pharma and Therapeutics

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The antibiotics dicloxacillin and flucloxacillin induce cytochrome P450‐dependent metabolism of warfarin. We explored the influence of these drug–drug interactions on the clinical effectiveness of warfarin therapy due to atrial fibrillation or heart valve replacement. Using the population‐based Danish registers, we performed a propensity‐score matched cohort study including around 50,000 episodes of dicloxacillin/flucloxacillin matched to phenoxymethylpenicillin and to no antibiotic, respectively. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) by comparing 21‐day (days 7–28) risks of ischemic stroke/systemic embolism (SE) following initiation of each exposure. When compared with phenoxymethylpenicillin, dicloxacillin/flucloxacillin was associated with an HR of ischemic stroke/SE of 2.09 (95% CI 1.51–2.90; strongest for dicloxacillin (HR 2.17; 95% CI 1.56–3.02)). Use of an untreated comparator strengthened the association (HR 2.84; 95% CI 1.97–4.09). Dicloxacillin should be used with caution in patients receiving warfarin. This may also apply to flucloxacillin; however, more data on the risks associated with flucloxacillin exposure during warfarin therapy are needed.

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Self-managed oral anticoagulant therapy: a call for implementation

Cited by 11 publications

References 19 publications

The effect of a nurse-led patient education program for oral anticoagulant therapy on the incidence of thromboembolic and hemorrhagic episodes after surgical heart valve replacement

The effect of a nurse-led patient education program for oral anticoagulant therapy on the incidence of thromboembolic and hemorrhagic episodes after surgical heart valve replacement

Predictors of anticoagulation quality in 15 834 patients performing patient self‐management of oral anticoagulation with vitamin K antagonists in real‐life practice: a survey of the International Self‐Monitoring Association of Orally Anticoagulated Patients

Ischemic Stroke and Systemic Embolism in Warfarin Users With Atrial Fibrillation or Heart Valve Replacement Exposed to Dicloxacillin or Flucloxacillin

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