Warfarin Management and Outcomes in Patients with Nonvalvular Atrial Fibrillation Within an Integrated Health Care System

Abstract

This research and manuscript were funded by Bristol-Myers Squibb Company and Pfizer. Authors from Bristol-Myers Squibb Company and Pfizer participated in the design of the study, interpretation of the data, review/revision of the manuscript, and approval of the final version of the manuscript. An received a grant for research support from Bristol-Myers Squibb/Pfizer. Niu, Rashid, and Zheng received a grant from Bristol-Myers Squibb/Pfizer to their institutions for salary reimbursement. Vo, Singh, and Aranda are employed by Bristol-Myers Squibb; Bruno was employed by Bristol-Myers Squibb at the time of this study. Mendes and Dills are employed by Pfizer, and Mendes was a member of the Pfizer Cardiovascular and Metabolic Field Medical Team during the time of this study. Lang, Jazdzewski, and Le have no known conflicts of interest to report. Study concept and design were contributed primarily by An and Rashid, along with the other authors. Niu took the lead in data collection, along with Zheng, and data interpretation was performed by An, along with Mendes and Dills, with assistance from the other authors. The manuscript was written by An and revised by Mendes, Dills, Vo, Singh, Bruno, and Aranda, along with Lang, Le, and Jazdezewski. Part of this study's findings was presented at the CHEST 2015 Annual Meeting in Montreal, Canada, on October 28, 2015.

Evaluation of Stable Doses of Warfarin in a Patient Cohort

“…A five-year study in United States in non-valvular atrial fibrillation patients on warfarin revealed that around two-thirds had at least one warfarin dose adjustment annually and annual attrition rate ranged between 3.3 and 6.3 %. [15] Except for one definition, that necessitates same warfarin dose at three consecutive clinic visits over a minimum period of 3 months with PT-INR in the therapeutic range, all other definitions were observed to have reasonable agreements in the present study. Hence, the IWPC algorithm [3] may not have any bias associated with inclusion of studies and can be evaluated in other studies.…”

Thromboprophylaxis for Patients with High-risk Atrial Fibrillation and Flutter Discharged from the Emergency Department

“…Oral anticoagulation medications in use within KPNC during the study period were warfarin and dabigatran, warfarin being the drug of choice at the time. Furthermore, each facility had its own pharmacy-managed, phone-based Outpatient Anticoagulation Service that managed outpatient warfarin use and provided close follow-up and monitoring of these patients, akin to similar programs in other KP regions in the U.S. 39 , 40 The percent time in therapeutic range for the international normalized ratio during the study period varied by facility and ranged from 70% to 74%, calculated with a six-month look-back period using the Rosendaal linear interpolation method. 41 …”

2020 Clinical guidelines for Atrial fibrillation and atrial flutter

“…• С целью повышения эффективности лечения большинству пациентов с ФП рекомендуется пожизненное диспансерное наблюдение с периодичностью визитов к врачу как минимум 2 раза в год [509,510].…”

“…• В рамках диспансерных осмотров пациентов с ФП рекомендуется регулярно оценивать наличие и динамику фоновых заболеваний и ФР с целью снижения риска осложнений [509,510].…”