The effect of management models on thromboembolic and bleeding rates in anticoagulated patients: an ecological study

Tosetto, Alberto; Testa, Sophie; Palareti, Gualtiero; Paoletti, Oriana; Nichele, Ilaria; Catalano, Francesca; Morandini, Rossella; Paolo, Maria Luisa Di; Tala, Maurizio; Esteban, Pilar; Corà, Francesco; Mannino, Salvatore; Maroni, Anna; Sessa, Maria; Castaman, Giancarlo

doi:10.1007/s11739-019-02148-7

Cited by 4 publications

(5 citation statements)

References 34 publications

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“…Anticoagulation Clinics (ACs) routinely manage thousands of patients taking anticoagulants, either vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs), or parenteral drugs. ACs are pivotal in anticoagulation management, providing site visits for patients, remote monitoring, and integration with local health facilities [2].The recent spreadout of the COVID-19 pandemic requires a re-organization also of ACs, to prevent person-to-person diffusion. As most of the patients taking oral anticoagulants show at least one comorbid condition, it is becoming more evident that the ACs should continue to offer the highest possible quality of assistance, while assuring all safety standards against viral transmission.…”

Section: Introductionmentioning

confidence: 99%

Managing anticoagulation in the COVID-19 era between lockdown and reopening phases

Poli

Tosetto

Palareti³

et al. 2020

Intern Emerg Med

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Patients on anticoagulant treatment are constantly increasing, with an estimated prevalence in Italy of 2% of the total population. The recent spreadout of the COVID-19 pandemic requires a reorganization of Anticoagulation Clinics to prevent person-to-person viral diffusion and continue to offer the highest possible quality of assistance to patients. In this paper, based on the Italian Federation of Anticoagulation Clinics statements, we offer some advice aimed at improving patient care during COVID-19 pandemic, with particular regard to the lockdown and reopening periods. We give practical guidance regarding the following points: (1) rethinking the AC organization, (2) managing patients on anticoagulants when they become infected by the virus, (3) managing anticoagulation surveillance in non-infected patients during the lockdown period, and (4) organizing the activities during the reopening phases.

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Section: Introductionmentioning

confidence: 99%

Managing anticoagulation in the COVID-19 era between lockdown and reopening phases

Poli

Tosetto

Palareti³

et al. 2020

Intern Emerg Med

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“…Even if also, in the Italian context, the national guidelines recognized SM models as a safe and effective practice for OAC patients, there is a lack of organizational and professional strategies to address barriers underpinning the implementation of SM in primary and secondary care settings (Tosetto et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Although the barriers identified in our study are aligned with the most common barriers described in the literature for the optimal management of OAC (Holbrook et al, 2021; Wang et al, 2020), to the best of our knowledge, these findings represent a novelty considering that the described barriers portray some Italian‐specific elements and viewpoints, which were previously unexplored. Even if also, in the Italian context, the national guidelines recognized SM models as a safe and effective practice for OAC patients, there is a lack of organizational and professional strategies to address barriers underpinning the implementation of SM in primary and secondary care settings (Tosetto et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…In the Italian context, roughly one million people are treated with OAC, and ACs are the leading management model (Tosetto et al, 2019); nonetheless, SM has potential to be the strategy to answer the increased health demands and the need to strengthen primary care services. A recent survey highlighted that only a few patients performed SM, and roughly 80% did not receive any educational training or attended any educational initiatives about adopting SM (Magon, Arrigoni, Barello, et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

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Barriers to self‐monitoring implementation in the oral anticoagulated population: A qualitative study

Magon

Arrigoni

Durante

et al. 2022

Int J of Nursing Practice

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Aim This study aimed to explore and understand the barriers perceived by Italian nurses to adopting self‐monitoring for managing oral anticoagulation in real‐life settings. Background Barriers to self‐monitoring implementation for managing oral anticoagulation have been poorly described. Design The study had a qualitative descriptive and exploratory design with a hybrid approach. Methods A literature review was conducted to identify a priori barriers (deductive approach), while a small and semi‐structured focus group discussion was performed to explore the contextual barriers experienced by Italian nurses (inductive approach). A classic content analysis technique was adopted. Data were collected in 2019. Findings Two main categories were identified. Organizational barriers referred to the lack of inter‐professional collaboration and health‐care system strategies to provide clinical pathways for self‐monitoring. Individual barriers encompassed professional characteristics (e.g. university background, professional knowledge, continuum education and accountability/responsibility) and patient characteristics (e.g. patient health literacy and knowledge, engagement/empowerment and educational programmes). Finally, unwarranted clinical variation in oral anticoagulation management arose as a barrier determined by organizational and individual elements. Conclusions The results of this study pointed out an urgent public health issue in addressing barriers influencing self‐monitoring practice and in sustaining care models that might enhance the quality improvement of self‐monitoring for managing oral anticoagulation.

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“…It has been shown that a comprehensive management model providing centralized dose prescription and followup may improve the outcome of VKA-treated patients. 22 This integrated approach is granted also in our NAS model, which connect specialists and GPs by a common management software, and by a shared training process about the VKA treatment.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of treatment with vitamin K antagonists in patients managed in a network of anticoagulation services or as routine general care

Girolamo

Sarti

Cecoli

et al. 2022

Bleed Thromb Vascul Biol

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This is a retrospective, record-linkage study aimed at comparing the effectiveness and safety of two management models of vitamin K antagonists: a Network model (NAS), in which anticoagulation clinics and general practitioners (GP) share the same management software and database, and an individual General Practitioners model. Main outcomes were thromboembolic events (TE), major bleeding (MB) and all-cause mortality. Crude incidence rate and sub-distribution hazard ratio were calculated. Fine and Grey models were used to calculate SHR in multi-variable analysis. 9,418 patients in the NAS and 5,508 in the Routine General Care (RGC) cohort were included. Patients in the NAS cohort had a lower incidence of TE and mortality in respect to the RGC (sHR 0.76%, 95% CI 0.64-0.90 and 0.82%, 95% CI 0.75-0.89, respectively). More patients in the NAS than in the RGC cohort attained a Time in Therapeutic Range >60% (62.2% vs 35.7%, p<0.001). No statistically significant difference was found in MB incidence. This study shows that the NAS model for vitamin K antagonist oral anticoagulants management significantly improves the TTR and reduces the incidence of TE and mortality, without affecting the MB rate.

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The effect of management models on thromboembolic and bleeding rates in anticoagulated patients: an ecological study

Cited by 4 publications

References 34 publications

Managing anticoagulation in the COVID-19 era between lockdown and reopening phases

Managing anticoagulation in the COVID-19 era between lockdown and reopening phases

Barriers to self‐monitoring implementation in the oral anticoagulated population: A qualitative study

Safety and efficacy of treatment with vitamin K antagonists in patients managed in a network of anticoagulation services or as routine general care

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