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Gammon R, Becker J, Cameron T, Eichbaum Q, Jindal A, Lamba DS, Nalezinski S, Rios J, Shaikh S, Shepherd J, Tanhehco YC. How do I manage a blood product shortage? Transfusion 2023; 63:2205-2213. [PMID: 37840217 DOI: 10.1111/trf.17572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The demand for blood products sometimes exceeds the available inventory. Blood product inventories are dependent upon the availability of donors, supplies and reagents, and collection staff. During prolonged extreme shortages, blood centers and transfusion services must alter practices to meet the needs of patients. STUDY DESIGN AND METHODS The Association for the Advancement of Blood and Biotherapies Donor and Blood Component Management Subsection compiled some strategies from its blood center and hospital transfusion service members that could be implemented during blood product shortages. RESULTS Some strategies that blood centers could use to increase their available inventories include increasing donor recruitment efforts, using alternate types of collection kits, manufacturing low-yield apheresis-derived platelets and/or whole blood-derived platelets, using cold-stored platelets, transferring inventory internally among centers of the same enterprise, using frozen inventory, decreasing standing order quantities, prioritizing allocation to certain patient populations, filling partial orders, and educating customers and blood center staff. Transfusion service strategies that could be implemented to maximize the use of the limited available inventory include increasing patient blood management efforts, using split units, finding alternate blood suppliers, trading blood products with other hospital transfusion services, developing a patient priority list, assembling a hospital committee to decide on triaging priorities, using expired products in extreme situations, and accepting nonconforming products after performing safety checks. DISCUSSION Blood centers and transfusion services must choose the appropriate strategies to implement based on their needs.
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Affiliation(s)
- Richard Gammon
- OneBlood, Scientific, Medical, Technical Direction, Orlando, Florida, USA
| | - Joanne Becker
- Department of Pathology and Laboratory Medicine; Blood Bank and Therapeutic Apheresis Unit, Roswell Park Comprehensive Cancer Center, and Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Tracy Cameron
- Ontario Regional Blood Coordinating Network, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Quentin Eichbaum
- Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA
| | - Aikaj Jindal
- Department of Transfusion Medicine, Mohandai Oswal Hospital, Ludhiana, India
| | - Divjot Singh Lamba
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shaughn Nalezinski
- Department of Laboratory Medicine Transfusion Services, Concord Hospital, Concord, New Hampshire, USA
| | - Jorge Rios
- American Red Cross Blood Services, Dedham, Massachusetts, USA
| | - Salima Shaikh
- Vitalant, Northeast Division, Montvale, New Jersey, USA
| | - Janine Shepherd
- Transfusion Services Laboratory, Denver Health Hospital, Denver, Colorado, USA
| | - Yvette C Tanhehco
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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George D, Wong CA, Thanimalai S, Tan HS. Severity and Hospitalization Cost Related to Warfarin-Related Adverse Events in a Tertiary Malaysian Hospital. Hosp Pharm 2022; 57:633-638. [PMID: 36081534 PMCID: PMC9445543 DOI: 10.1177/00185787211070182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Introduction: Oral anticoagulant is essential for the treatment and prevention of thromboembolism. Warfarin is an effective oral anticoagulant in prevention and treatment of thromboembolism. However, warfarin is frequently associated with adverse event (AE) requiring hospitalization. Method: We performed a retrospective cohort study of all patients admitted to a large tertiary public hospital for warfarin-related AEs. Patients were grouped based on bleeding severity and the direct medical cost was also calculated. Results: During the 4 years study period, a total of 224 patients were admitted for warfarin-related AEs. Mean age of patients admitted was 65.1 years (standard deviation [SD] = 11.5). More than half, 59.6%, of them were on warfarin for prevention of stroke in atrial fibrillation or atrial flutter. Major bleeding occurred among 50.9% of the patients with gastrointestinal bleed, 34 (29.8%), as the common site of bleed. Patients with major bleed had longer median hospital stay of 4 days (interquartile range [IQR] = 5) compared to 3 (IQR = 3) days in non-major bleed. There were 17 (14.9%) death among the major bleeders. Mean medical cost for managing warfarin-related AEs was USD 708.08. Conclusion: The admitted patients were equally distributed in terms of bleeding severity. Medical cost incurred for managing warfarin-related AEs increased with the severity of bleeding.
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Affiliation(s)
- Doris George
- Hospital Raja Permaisuri Bainun, Ipoh, Perak, Ministry of Health Malaysia
| | - Chung Aun Wong
- Hospital Raja Permaisuri Bainun, Ipoh, Perak, Ministry of Health Malaysia
| | | | - Hoo Seng Tan
- Hospital Raja Permaisuri Bainun, Ipoh, Perak, Ministry of Health Malaysia
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Nalezinski S. Methods to Correct Drug-Induced Coagulopathy in Bleeding Emergencies: A Comparative Review. Lab Med 2022; 53:336-343. [PMID: 35073576 DOI: 10.1093/labmed/lmab115] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Anticoagulant and antiplatelet therapy have become increasingly popular. The goal of therapy is to prevent venous thromboembolism and platelet aggregation, respectively. Traditional anticoagulant and antiplatelet drugs are quickly being replaced with novel medications with more predictable pharmacokinetics. Unfortunately, these drugs carry the risk of uncontrolled hemorrhage because of drug-induced coagulopathy. Uncontrolled hemorrhage continues to be a major cause of preventable death: hemorrhage accounts for approximately 30% of trauma-related deaths, second to brain injury. Controlling hemorrhage while dealing with comorbidities remains a challenge to clinicians. There are many gaps in care and knowledge that contribute to the struggle of treating this patient population. METHODS This literature review is focused on the most effective ways to achieve hemostasis in a patient with drug-induced coagulopathy. The antiplatelet therapies aspirin, clopidogrel, ticlopidine, pasugrel, and ticagrelor are analyzed. Anticoagulant therapies are also reviewed, including warfarin, rivaroxaban, apixaban, edoxaban, and dabigatran. In addition, viscoelastic testing and platelet function assays are reviewed for their ability to monitor drug effectiveness and to accurately depict the patient's ability to clot. This review focuses on articles from the past 10 years. However, there are limitations to the 10-year restriction, including no new research posted within the 10-year timeline on particular subjects. The most recent article was then used where current literature did not exist (within 10 years). RESULTS Traditional anticoagulants have unpredictable pharmacokinetics and can be difficult to correct in bleeding emergencies. Vitamin K has been proven to reliably and effectively reverse the effect of vitamin K antagonists (VKAs) while having a lower anaphylactoid risk than frozen plasma. Prothrombin complex concentrates should be used when there is risk of loss of life or limb. Frozen plasma is not recommended as a first-line treatment for the reversal of VKAs. Novel anticoagulants have specific reversal agents such as idarucizumab for dabigatran and andexxa alfa for factor Xa (FXa) inhibitors. Although reliable, these drugs carry a large price tag. As with traditional anticoagulants, cheaper alternative therapies are available such as prothrombin complex concentrates. Finally, static coagulation testing works well for routine therapeutic drug monitoring but may not be appropriate during bleeding emergencies. Viscoelastic testing such as thromboelastography and rotational thromboelastometry depict in vivo hemostatic properties more accurately than static coagulation assays. Adding viscoelastic testing into resuscitation protocols may guide blood product usage more efficiently. CONCLUSION This review is intended to be used as a guide. The topics covered in this review should be used as a reference for treating the conditions described. This review article also covers laboratory testing and is meant as a guide for physicians on best practices. These findings illustrate recommended testing and reversal techniques based off evidence-based medicine and literature.
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Affiliation(s)
- Shaughn Nalezinski
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Carabineanu A, Zaharia C, Blidisel A, Ilina R, Miclaus C, Ardelean O, Preda M, Mazilu O. Risk of More Advanced Lesions at Hysterectomy after Initial Diagnosis of Non-Atypical Endometrial Hyperplasia in Patients with Postmenopausal Bleeding and Oral Anticoagulant Treatment. ACTA ACUST UNITED AC 2021; 57:medicina57101003. [PMID: 34684040 PMCID: PMC8539967 DOI: 10.3390/medicina57101003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022]
Abstract
Background and Objectives: Endometrial hyperplasia (EH) is a precursor lesion to endometrial cancer (EC), and when cellular atypia is present, in 40% of cases, they are diagnosed with EC on hysterectomy. Usually, EH is clinically manifested by uterine bleeding. In patients with oral anticoagulant therapy (OAT), the uterus is the second most common source of bleeding. The aim of the study was to show that uterine bleeding in postmenopausal patients undergoing OAT may reveal precancerous endometrial lesions with atypia, or neoplastic lesions in patients with an initial diagnosis of endometrial hyperplasia without atypia (non-atypical endometrial hyperplasia, NAEH) on dilation and curettage (D&C). We will be able to estimate the risk of a postmenopausal female patient with uterine bleeding during an OAT to have a precancerous endometrial lesion. Materials and Methods: The subjects of the study were 173 female patients with uterine bleeding, who have had total hysterectomy with bilateral salpingoovarectomy, of whom 99 underwent an OAT. There were 101 female patients initially diagnosed with NAEH, of which 60 did not have anticoagulant treatment (mean age 57.36 ± 6.51) and 41 had anticoagulant treatment (mean age 60.39 ± 7.35) (p = 0.006). From the pathology diagnosis moment, the surgery was performed at 42.09 ± 14.54 days in patients without OAT and after 35.39 ± 11.29 days in those who received such treatment (p = 0.724). Results: Initial diagnosis of NAEH established at D&C was changed at the final diagnosis after hysterectomy in EH with cellular atypia (atypical endometrial hyperplasia AEH) or EC in 18.18% of patients without OAT, and in 40.54% of patients who received this treatment. Conclusions: Based on a logistic regression model, it is estimated that female patients with an initial histopathological diagnosis of NAEH and who underwent OAT have, on average, 4.85 times greater odds (OR = 4.85, 95% CI 1.79–14.06) than the others of being identified postoperatively with more advanced lesions.
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Affiliation(s)
- Adrian Carabineanu
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Claudia Zaharia
- Department of Mathematics, Faculty of Mathematics and Computer Science, West University of Timisoara, 300223 Timisoara, Romania;
| | - Alexandru Blidisel
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
- Correspondence:
| | - Razvan Ilina
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Codruta Miclaus
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Ovidiu Ardelean
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Marius Preda
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Octavian Mazilu
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
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Magon A, Arrigoni C, Fava A, Pittella F, Villa G, Dellafiore F, Conte G, Caruso R. Nursing self-efficacy for oral anticoagulant therapy management: Development and initial validation of a theory-grounded scale. Appl Nurs Res 2021; 59:151428. [PMID: 33947515 DOI: 10.1016/j.apnr.2021.151428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 02/02/2023]
Abstract
AIM This study aimed to develop and validate a nursing self-efficacy scale for OAC management (SE-OAM). BACKGROUND Oral anticoagulant therapy (OAC) requires specific nursing competencies. Given that self-efficacy acts as a proxy assessment of nursing competence, its measurement is pivotal for addressing educational programs to enhance nursing competence in managing OAC. Thus far, the measurement of self-efficacy in OAC is undermined by the unavailability of valid and reliable tools. METHODS A multi-method and multi-phase design was adopted: Phase one was a methodological study encompassing developmental tasks for generating items. Phase two comprised the validation process for determining the content validity, construct and concurrent validity, and internal consistency through two cross-sectional data collections. RESULTS In total, 190 nurses were enrolled for determining the psychometric structure of the SE-OAM through an exploratory approach, and 345 nurses were subsequently enrolled to corroborate its most plausible factor structure derived from the exploratory analysis. The SE-OAM showed evidence of face and content validity, adequate construct, concurrent validity, good internal consistency, and stability. The final version of the scale encompassed 21 items kept by five domains: clinical management, care management, education, clinical monitoring, and care monitoring. CONCLUSIONS The SE-OAM showed evidence of initial validity and reliability, fulfilling a current gap in the availability of tools for measuring nursing self-efficacy in managing OAC. SE-OAM could be strategic for performing research to improve the quality of OAC management by enhancing nursing self-efficacy.
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Affiliation(s)
- Arianna Magon
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Alberto Fava
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Francesco Pittella
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Giulia Villa
- Unit of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Gianluca Conte
- Paediatric Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy.
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Quintas S, Zapata-Wainberg G, Arias-Rivas S, Ximénez-Carrillo Á, Castillo J, Benavente Fernández L, Masjuan Vallejo J, Freijó Guerrero MDM, Egido J, García Pastor A, Cardona P, Lago A, Castellanos Rodrigo M, Fuentes B, Sobrado M, Vivancos J. Time Trends in Intracerebral Hemorrhage Associated with Oral Anticoagulation and Its Risks Factors in Spain from 2008 to 2015. Eur Neurol 2020; 84:16-21. [PMID: 33321486 DOI: 10.1159/000511603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/08/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is 7- to 10-fold higher in anticoagulated patients. Given the more extended use of oral anticoagulants, an increase in the prevalence of ICH associated with oral anticoagulation (ICH-OAC) could be expected. However, there is no previous study that assesses the time trends of ICH-OAC in Spain. METHODS We conducted a combined data analysis after creating a joint database of the 3 most important epidemiological studies on ICH-OAC of our country: the EPICES study (2008-2009), the TAC Registry (TR) study (2012-2013) and the TAC Registry 2 (TR2) study (2015). We finally included 65, 235, and 366 patients from the EPICES, TR, and TR2 studies, respectively. RESULTS We have observed a 3.73-fold increase in the crude annual incidence of ICH-OAC throughout the period of study, with proportion of ICH-OAC out of total ICH increasing from 8.4% in 2008 to 18.2% in 2015. Age, dyslipidemia, and prior antiplatelet treatment increased during the study, but we found no statistically significant differences in other risk factors for ICH-OAC. CONCLUSIONS The incidence of ICH-OAC is increasing in our country. It might at least be partly explained by aging of the population, with mean age at presentation being higher in the last years.
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Affiliation(s)
- Sonia Quintas
- Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain,
| | - Gustavo Zapata-Wainberg
- Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | | | - Álvaro Ximénez-Carrillo
- Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Jose Castillo
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Jaime Masjuan Vallejo
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | | | - José Egido
- Hospital Clínico San Carlos, Madrid, Spain
| | | | - Pere Cardona
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Aida Lago
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Mar Castellanos Rodrigo
- Complejo Hospitalario Universitario A Coruña, Instituto de Investigacion Biomédica A Coruña, Coruña, Spain
| | - Blanca Fuentes
- Instituto de Investigación Sanitaria La Paz, Departamento de Medicina, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Mónica Sobrado
- Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Jose Vivancos
- Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
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Martín-Bailón M, López-Mesa P, Dios-Loureiro C. Manejo de epistaxis en pacientes con terapia antitrombótica. REVISTA ORL 2020. [DOI: 10.14201/orl.24097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción y objetivo: la epistaxis es una de las urgencias otorrinolaringológicas más frecuentes. Una de sus causas son las alteraciones de la hemostasia provocadas por fármacos antitrombóticos. El objetivo del estudio es determinar si existen diferencias en el manejo de epistaxis entre pacientes con terapia antitrombótica y pacientes controles.
Método: estudio observacional analítico retrospectivo de pacientes ingresados en el servicio de Otorrinolaringología de un hospital de tercer nivel, entre enero de 2010 y diciembre de 2016. Se han recogido características epidemiológicas, clínicas y terapéuticas de los pacientes a través de su historia clínica electrónica y se ha realizado análisis estadístico comparativo entre los pacientes con terapia antitrombótica y pacientes controles.
Resultados: 85 pacientes analizados (74,1% varones) con una edad media al diagnóstico de 66,7 años. El 49,4% realizaban terapia antitrombótica. En todos los pacientes se realizó taponamiento anterior y en 16 pacientes, posterior. 37 pacientes precisaron cirugía endoscópica nasal. La embolización se realizó en cuatro pacientes. En el estudio estadístico comparativo no se han encontrado diferencias estadísticamente significativas entre ambos grupos en ninguna de las variables analizadas.
Discusión y conclusiones: las indicaciones actuales de terapia antitrombótica son muy amplias y por ello es frecuente atender epistaxis en este tipo de pacientes. Aunque no está claramente demostrado que la terapia antitrombótica por sí sola se asocie con sangrados más graves, creemos que es fundamental realizar un manejo multidisciplinar de estos pacientes con el fin de conseguir un adecuado control del sangrado sin necesidad de recurrir a intervenciones más agresivas.
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Direct-acting Oral Anticoagulants in Dermatologic Surgery. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Cabezas-Calderon V, Bassas Freixas P, García-Patos Briones V. Anticoagulantes orales directos en cirugía dermatológica. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:357-363. [DOI: 10.1016/j.ad.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 12/13/2022] Open
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Magon A, Arrigoni C, Moia M, Mancini M, Dellafiore F, Manara DF, Caruso R. Determinants of health-related quality of life: a cross-sectional investigation in physician-managed anticoagulated patients using vitamin K antagonists. Health Qual Life Outcomes 2020; 18:73. [PMID: 32178684 PMCID: PMC7077005 DOI: 10.1186/s12955-020-01326-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/11/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Literature has paid little attention in describing the specific contribution of each modifiable and non-modifiable characteristics on health-related quality of life (HRQoL) in physician-managed anticoagulated patients using vitamin K antagonists (VKAs). To describe how patients' treatment-specific knowledge, health literacy, treatment beliefs, clinical, and socio-demographic characteristics influence HRQoL in Italian physician-managed anticoagulated patients using VKAs. METHODS Cross-sectional multicentre study with a consecutive sampling strategy, enrolling 164 long-term anticoagulated patients. Clinical and socio-demographic characteristics were collected from electronic medical records. Valid and reliable questionnaires were used to collect patients' treatment-specific knowledge, health literacy, beliefs about VKAs, physical and health perceptions. RESULTS Obtaining and understanding health information (i.e., communicative health literacy) positively predicts both adequate mental (ORadjusted = 10.9; 95%CI = 1.99-19.10) and physical (ORadjusted = 11.54; 95%CI = 1.99-34.45) health perceptions. Conversely, the ability to perform proper health decision making (i.e., critical health literacy) was associated with lower rates of adequate mental health perception (ORadjusted = 0.13; 95%CI = 0.03-0.63). Further, age negatively predicted physical health perception (ORadjusted = 0.87; 95%CI = 0.81-0.93). CONCLUSIONS Health literacy plays an interesting role in predicting HRQoL. The relationship between critical health literacy and mental health perception could be influenced by some psychological variables, such as distress and frustration, which could be present in patients with higher levels of critical health literacy, as they could be more inclined for self-monitoring. For this reason, future research are needed to identify the most suitable patients' profile for each OAC-management model, by longitudinally describing the predictive performance of each modifiable and non-modifiable determinant of HRQoL.
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Affiliation(s)
- Arianna Magon
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, Italy.
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Marco Moia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Michela Mancini
- Nursing Office, ASST Melegnano e della Martesana, Melzo, Italy
| | - Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Duilio F Manara
- School of Nursing, Vita-Salute San Raffaele University, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Tension subcutaneous haematomas associated with anticoagulants in the elderly: Do they have earlier morbidity and mortality than hip fractures? Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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12
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Determining the necessity of phenyl ring π-character in warfarin. Bioorg Med Chem Lett 2019; 29:1954-1956. [PMID: 31147103 DOI: 10.1016/j.bmcl.2019.05.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/18/2019] [Accepted: 05/18/2019] [Indexed: 11/23/2022]
Abstract
Despite the difficulty in administering a safe dose regimen and reports of emerging resistance, warfarin (1) remains the most widely-used oral anticoagulant for the prevention and treatment of thrombosis in humans globally. Systematic substitution of the warfarin phenyl ring with either 1,3,5,7-cyclooctatetraene (COT) (2), cubane (3), cyclohexane (4) or cyclooctane (5) and subsequent evaluation against the target enzyme, vitamin K epoxide reductase (VKOR), facilitated interrogation of both steric and electronic properties of the phenyl pharmacophore. The tolerance of VKOR to further functional group modification (carboxylate 14, PTAD adduct 15) was also investigated. The results demonstrate the importance of both annulene conferred π-interactions and ring size in the activity of warfarin.
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Tension subcutaneous haematomas associated with anticoagulants in the elderly: Do they have earlier morbidity and mortality than hip fractures? Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:361-369. [PMID: 31014931 DOI: 10.1016/j.recot.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/19/2019] [Accepted: 02/25/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Complications related to anticoagulant therapy have been widely described, although tension haematomas in the extremities are frequently undervalued, and commonly considered banal pathologies. MATERIAL AND METHOD Retrospective descriptive study between 2014 and 2017, including patients with limb haematomas after minimal trauma related with anticoagulant therapy, and surgically treated by Traumatology. RESULTS 32 cases were eventually included, 81% were women, average age of 83.56 years, and a mean aCCI of 5.97. Anatomical location of haematomas was 65.6% in leg/foot, 15.6% in thigh/buttock, and 18.8% in the upper limb. Seventy-eight point thirteen percent received acenocoumarol, 15.63% LMWH, and 3.13% NOACs. Of the cases, 59.38% were due to AF, 15.63% to valvular heart disease/valve prosthesis, and 12.5% to PE/DVT. The mean time from diagnosis to surgical drainage was 2.66 days, mainly as a result of alterations in coagulation parameters. Forty-six point eighty-eight percent were reoperated for new drainage, cure or skin defect coverage, and 3 patients required embolisation. Of the patients, 78% needed consultation with other specialties. The average length of stay was 22.34 days, and the in-hospital mortality rate was 9.38%. CONCLUSION Tension haematomas in the extremities associated with anticoagulants occur in patients with multiple comorbidities that make them vulnerable. Surgical drainage is usually delayed by numerous factors which lead to skin defects that require further surgical operations, and prolonged hospital stays that are associated with medical complications. In our study, the average length of stay and in-hospital mortality rate were higher than those for hip fractures, so we should not underestimate this pathology.
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Caballero Requejo C, Urbieta Sanz E, Iniesta Navalón C, Gascón Cánovas JJ. [Incorporation of direct-acting oral anticoagulants to available therapeutic arsenal: Progress adequately?]. Aten Primaria 2019; 51:184-185. [PMID: 30660438 PMCID: PMC6837083 DOI: 10.1016/j.aprim.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/28/2018] [Accepted: 11/03/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Elena Urbieta Sanz
- Servicio de Farmacia, Hospital General Universitario Reina Sofía, Murcia, España
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15
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Xing H, Houston SD, Chen X, Ghassabian S, Fahrenhorst-Jones T, Kuo A, Murray CEP, Conn KA, Jaeschke KN, Jin DY, Pasay C, Bernhardt PV, Burns JM, Tsanaktsidis J, Savage GP, Boyle GM, De Voss JJ, McCarthy J, Walter GH, Burne THJ, Smith MT, Tie JK, Williams CM. Cyclooctatetraene: A Bioactive Cubane Paradigm Complement. Chemistry 2019; 25:2729-2734. [PMID: 30681236 PMCID: PMC6436534 DOI: 10.1002/chem.201806277] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Indexed: 12/14/2022]
Abstract
Cubane was recently validated as a phenyl ring (bio)isostere, but highly strained caged carbocyclic systems lack π character, which is often critical for mediating key biological interactions. This electronic property restriction associated with cubane has been addressed herein with cyclooctatetraene (COT), using known pharmaceutical and agrochemical compounds as templates. COT either outperformed or matched cubane in multiple cases suggesting that versatile complementarity exists between the two systems for enhanced bioactive molecule discovery.
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Affiliation(s)
- Hui Xing
- School of Chemistry and Molecular Biosciences, University of Queensland (UQ), Brisbane, 4072, Queensland (QLD, Australia
| | - Sevan D Houston
- School of Chemistry and Molecular Biosciences, University of Queensland (UQ), Brisbane, 4072, Queensland (QLD, Australia
| | - Xuejie Chen
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Sussan Ghassabian
- Centre for Integrated Preclinical Drug Development, University of Queensland (UQ), Australia
| | - Tyler Fahrenhorst-Jones
- School of Chemistry and Molecular Biosciences, University of Queensland (UQ), Brisbane, 4072, Queensland (QLD, Australia
| | - Andy Kuo
- Centre for Integrated Preclinical Drug Development, University of Queensland (UQ), Australia
| | | | - Kyna-Anne Conn
- Queensland Brain Institute, University of Queensland (UQ), Australia
| | - Kara N Jaeschke
- Queensland Brain Institute, University of Queensland (UQ), Australia
| | - Da-Yun Jin
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Cielo Pasay
- QIMR Berghofer Medical Research Institute, PO Royal Brisbane Hospital, Brisbane, 4029, QLD, Australia
| | - Paul V Bernhardt
- School of Chemistry and Molecular Biosciences, University of Queensland (UQ), Brisbane, 4072, Queensland (QLD, Australia
| | - Jed M Burns
- School of Chemistry and Molecular Biosciences, University of Queensland (UQ), Brisbane, 4072, Queensland (QLD, Australia
| | - John Tsanaktsidis
- CISRO Manufacturing, Ian Wark Laboratory, Melbourne, 3168, Victoria (VIC, Australia
| | - G Paul Savage
- CISRO Manufacturing, Ian Wark Laboratory, Melbourne, 3168, Victoria (VIC, Australia
| | - Glen M Boyle
- QIMR Berghofer Medical Research Institute, PO Royal Brisbane Hospital, Brisbane, 4029, QLD, Australia
| | - James J De Voss
- School of Chemistry and Molecular Biosciences, University of Queensland (UQ), Brisbane, 4072, Queensland (QLD, Australia
| | - James McCarthy
- QIMR Berghofer Medical Research Institute, PO Royal Brisbane Hospital, Brisbane, 4029, QLD, Australia
| | - Gimme H Walter
- School of Biological Sciences, University of Queensland (UQ), Australia
| | - Thomas H J Burne
- Queensland Brain Institute, University of Queensland (UQ), Australia
| | - Maree T Smith
- Centre for Integrated Preclinical Drug Development, University of Queensland (UQ), Australia
| | - Jian-Ke Tie
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Craig M Williams
- School of Chemistry and Molecular Biosciences, University of Queensland (UQ), Brisbane, 4072, Queensland (QLD, Australia
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Cabellos-García AC, Martínez-Sabater A, Castro-Sánchez E, Kangasniemi M, Juárez-Vela R, Gea-Caballero V. Relation between health literacy, self-care and adherence to treatment with oral anticoagulants in adults: a narrative systematic review. BMC Public Health 2018; 18:1157. [PMID: 30286744 PMCID: PMC6172776 DOI: 10.1186/s12889-018-6070-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 09/25/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Oral anticoagulants (OAC) are widely used in patients with cardiovascular diseases. However, for optimal OAC self-care patients must have skills, among which health literacy (HL) is highlighted. We aimed to describe the relation between HL and self-care in cardiovascular patients on OAC treatment. METHODS Electronic searches were carried out in the PubMed, Scopus, Embase, CINAHL, Web of Science, Cochrane Library, SciELO, IME-Biomedicina, CUIDEN Plus and LILACS databases, limited to Spanish and English language and between January 2000-December 2016. Papers reported on adults older than 18 years, taking OAC by themselves for at least three months. PRISMA guidelines were used for paper selection. RESULTS We identified 142 articles and finally included 10; almost all of them about warfarin. Our results suggest that in patients taking OAC treatments there is a positive relationship between HL and the level of knowledge. In addition, a small percentage of participants on the selected papers recognized the side effects and complications associated with OAC treatment. Lower HL level was associated with greater knowledge deficits and less adherence to treatment. CONCLUSION There is a paucity of research evaluating the effect of HL on diverse aspects of OAC treatments. There is a need to expand the evidence base regarding appropriate HL screening tools, determinants of adequate knowledge and optimal behaviours related to OAC self-management.
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Affiliation(s)
| | | | - Enrique Castro-Sánchez
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, Du Cane Road, W12 0NN, London, UK
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Raul Juárez-Vela
- Universidad San Jorge de Zaragoza, Villanueva de Gállego, Zaragoza, Spain
| | - Vicente Gea-Caballero
- Escuela de Enfermería La Fe, centro adscrito Universidad de Valencia, Valencia, Spain
- Instituto de Investigación La Fe. Grupo de investigación GREIACC, Valencia, Spain
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Prognostic factors and analysis of mortality due to brain haemorrhages associated with vitamin K antagonist oral anticoagulants. Results from the TAC Registry. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Zapata-Wainberg G, Quintas S, Ximénez-Carrillo Rico A, Benavente Fernández L, Masjuan Vallejo J, Gállego Culleré J, Freijó Guerrero MDM, Egido J, Gómez Sánchez J, Martínez Domeño A, Purroy F, Vives Pastor B, Rodríguez Yáñez M, Vivancos J. Factores pronósticos y análisis de la mortalidad de las hemorragias cerebrales asociadas a anticoagulantes orales antagonistas de la vitamina K. Resultados del Estudio TAC Registry. Neurologia 2018; 33:419-426. [DOI: 10.1016/j.nrl.2016.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/06/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022] Open
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Márquez-Contreras E, Martell-Carlos N, Gil-Guillén V, De La Figuera-Von Wichmann M, Sanchez-López E, Márquez-Rivero S, Gil-Gil I, Hermida-Campa E. Therapeutic compliance with rivaroxaban in preventing stroke in patients with non-valvular atrial fibrillation: CUMRIVAFA study. Curr Med Res Opin 2016; 32:2013-2020. [PMID: 27548637 DOI: 10.1080/03007995.2016.1227311] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess compliance with treatment with rivaroxaban in patients with non-valvular atrial fibrillation. METHODS Prospective, longitudinal, multicenter study, developed in 160 Spanish primary or specialized care centers. We included 412 patients treated with rivaroxaban, prescribed for stroke prevention. Three visits were conducted: baseline, 6 and 12 months. Compliance was measured by using electronic monitors (MEMSs) that use a digital record in the form of a microchip in the lid of the drug container that automatically controls its opening and registers the time and date of the opening. We calculated the average compliance percentage (CP), global and daily compliance. We considered compliance to be when CP was 80-100%. RESULTS Three hundred and seventy patients ended the study (mean age 75.19, SD: 7.5 years). Global compliance was 84.1% (CI = 79.21-88.99%) and 80.3% (CI = 74.98-85.62%) after 6 and 12 months respectively. Daily compliance was 83.5% (CI = 78.53-88.57%) and 80% (CI = 74.65-85.35%) at 6 and 12 months. Significant differences in the CP between 6 and 12 months were observed. Global CP was 90.77% after 6 months and 89.65% at the end of the study. Daily CP was 90.14% and 87.66% at 6 and 12 months. There were significant CP differences between 6 and 12 months. Non-compliance was associated with a higher number of concomitant diseases, number of drugs taken and weight. CONCLUSIONS The percentage of compliance with rivaroxaban was high. A profile of variables that need to be modified in current medical practice, associated with non-compliance, was detected.
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Affiliation(s)
| | | | | | | | | | | | - Ines Gil-Gil
- f Vieilla Health Center, Vieilla , Lleida , Spain
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Gómez DA, Coello J, Maspoch S. Raman spectroscopy for the analytical quality control of low-dose break-scored tablets. J Pharm Biomed Anal 2016; 124:207-215. [DOI: 10.1016/j.jpba.2016.02.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/25/2016] [Accepted: 02/28/2016] [Indexed: 11/29/2022]
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Millar JA, Gee ALK. Estimation of clinical and economic effects of prophylaxis against venous thromboembolism in medical patients, including the effect of targeting patients at high-risk. Intern Med J 2016; 46:315-24. [DOI: 10.1111/imj.12995] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 10/07/2015] [Accepted: 01/02/2016] [Indexed: 01/10/2023]
Affiliation(s)
- J. A. Millar
- Department of Medicine; Albany Regional Hospital; Albany Australia
- Medical Education; Curtin University; Perth Western Australia Australia
| | - A. L. K. Gee
- Department of Medicine; Royal Perth Hospital; Perth Western Australia Australia
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Millar JA. Effect of medical thromboprophylaxis on mortality from pulmonary embolus and major bleedingy. Australas Med J 2015; 8:286-91. [PMID: 26464585 PMCID: PMC4592944 DOI: 10.4066/amj.2015.2447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Several studies have failed to discover a beneficial effect of medical thromboprophylaxis on mortality. AIMS To examine the relative influence of acute fatal pulmonary embolism (PE) and fatal major haemorrhage on overall mortality in medical patients treated with low molecular weight heparin (LMWP) for prophylaxis. METHODS The author compared deaths from the above factors using data from a recent Cochrane Collaboration meta-analysis. Data from trials satisfying the criteria of the Cochrane analysis plus additional exclusions to avoid bias were pooled to produce point estimates of mortality from PE and major bleeds to estimate net mortality benefit. Estimates were then subject to limited sensitivity analysis based on reported epidemiological data. RESULTS Reported PE and major bleeds were 0.44 per cent and 0.27 per cent, respectively. The corresponding case-specific mortality rates were 30.8 per cent and 12.8 per cent and the relative risk reduction (RRR) for PE was 23.2 per cent. Estimated deaths from major bleeds exceeded PE deaths avoided by a small margin (3/100,000 patients given prophylaxis). This excess increased to 30/100,000 when more plausible literature values for PE case fatality rates were applied. CONCLUSION Medical thromboprophylaxis has a finely balanced effect on mortality but may increase it. Such an effect would explain the failure to discover a mortality benefit from medical thromboprophylaxis. Further work, including a formal meta-analysis and additional clinical studies, is required to confirm this picture.
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Affiliation(s)
- J Alasdair Millar
- Department of Medicine, Albany Regional Hospital, Albany, WA, Australia
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Zapata-Wainberg G, Ximénez-Carrillo Rico Á, Benavente Fernández L, Masjuan Vallejo J, Gállego Culleré J, Freijó Guerrero MDM, Egido J, Gómez Sánchez JC, Martínez Domeño A, Purroy García F, Vives Pastor B, Blanco González M, Vivancos J. Epidemiology of Intracranial Haemorrhages Associated with Vitamin K Antagonist Oral Anticoagulants in Spain: TAC Registry. INTERVENTIONAL NEUROLOGY 2015; 4:52-8. [PMID: 26600798 DOI: 10.1159/000437150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vitamin K antagonist oral anticoagulants (VKA-OACs) are effective for primary and secondary prevention of embolic events. The rate of haemorrhagic neurological complications in patients admitted to neurology departments in Spain is not yet known. AIMS We aimed to determine the clinical and epidemiological characteristics of patients with intracranial haemorrhage secondary to VKA-OACs as well as the incidence of this severe complication. METHODS We conducted a retrospective, descriptive, multi-centre study using information from the medical records of all patients admitted to neurology departments, diagnosed with spontaneous intracranial haemorrhage, and treated with VKA-OACs within a 1-year period. We collected demographic and care data from centres, patients' medical records [demographic data, medical history, haemorrhage origin, vascular risk factors, concomitant treatment, and National Institutes of Health Stroke Scale (NIHSS) scores], and patients' outcome at 3 months [independence (modified Rankin Scale score <3) and mortality rate]. RESULTS Twenty-one hospitals serving a population of 8,155,628 inhabitants participated in the study. The total number of cases was 235, the mean age was 78.2 (SD 9.4) years, and the baseline NIHSS score was 11.6 (SD 9.5; median 9; interquartile range 14). The VKA-OACs used were acenocoumarol in 95.3% (224 patients) and warfarin in 4.7% (11 patients). The haemorrhage origin was deep in 29.8%, lobar in 25.5%, intraventricular in 11.5%, extensive in 17.4% (>100 ml), cerebellar in 12.3%, and in the brainstem in 3.4%. The international normalised ratio was within therapeutic ranges at admission (according to indication) in 29.4% (69 patients). The global incidence (cases per 100,000 inhabitants per year) is 2.88. The in-hospital mortality rate was 40%, and 24.3% of the patients were independent at 3 months, while the mortality at 3 months was 42.6%. CONCLUSION VKA-OAC treatment is associated with a large percentage of all cases of spontaneous intracranial haemorrhage, an event leading to high dependence and mortality rates.
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Affiliation(s)
- Gustavo Zapata-Wainberg
- Neurology Department at Hospital Universitario de La Princesa, Spain ; Neurology Department at Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Álvaro Ximénez-Carrillo Rico
- Neurology Department at Hospital Universitario de La Princesa, Spain ; Neurology Department at Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | | | | | | | | | - José Egido
- Neurology Department at Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | | | | | - Miguel Blanco González
- Neurology Department at Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - José Vivancos
- Neurology Department at Hospital Universitario de La Princesa, Spain ; Neurology Department at Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
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Alonso Roca R, Figueroa Guerrero CA, Mainar de Paz V, Arribas García MP, Sánchez Perruca L, Rodríguez Barrientos R, Casado López M, Pedraza Flechas AM. Grado de control del tratamiento anticoagulante oral en los centros de Atención Primaria de la Comunidad de Madrid: estudio CHRONOS-TAO. Med Clin (Barc) 2015; 145:192-7. [DOI: 10.1016/j.medcli.2014.09.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 09/22/2014] [Accepted: 09/25/2014] [Indexed: 12/21/2022]
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Carles M, Brosa M, Souto JC, Garcia-Alamino JM, Guyatt G, Alonso-Coello P. Cost-effectiveness analysis of dabigatran and anticoagulation monitoring strategies of vitamin K antagonist. BMC Health Serv Res 2015; 15:289. [PMID: 26215871 PMCID: PMC4515878 DOI: 10.1186/s12913-015-0934-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 06/29/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Vitamin K antagonists are commonly used for the prevention of thromboembolic events. Patient self-monitoring of vitamin K antagonists has proved superior to usual care. Dabigatran has been shown, relative to warfarin, to reduce thromboembolic events without increasing bleeding. METHODS We constructed a Markov model to compare vitamin K self-monitoring strategies to dabigatran including effectiveness and costs of monitoring and complications (thromboembolism and major bleeding). The model was used to project the incidence of these complications, life years, quality-adjusted life years, and health system costs with anticoagulant treatment throughout life. The analysis was conducted from the health system perspective and from the societal perspective. RESULTS Low quality evidence suggests that self-monitoring is at least as effective as dabigatran for the outcomes of thrombosis, bleeding and death. Moderate quality evidence that patient self-monitoring is more effective than other forms of monitoring degree of anticoagulation with vitamin K antagonists, reducing the relative risk of thromboembolism by 41% and death by 34%. The cost per quality adjusted year gained relative to other warfarin monitoring strategies is well below 30,000 € in the short term, and is a dominant alternative from the fourth year. In comparison with dabigatran, the lower annual cost and its equivalence in terms of effectiveness made self-monitoring the dominant option. These results were confirmed in the probabilistic sensitivity analysis. CONCLUSIONS We have moderate quality evidence that self-monitoring of vitamin K antagonists is a cost-effective alternative compared with hospital and primary care monitoring, and low quality evidence, compared with dabigatran. Our analyses contrast with the available cost analysis of dabigatran and usual care of anticoagulated patients.
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Affiliation(s)
- Misericòrdia Carles
- Departament d'Economia and CREIP, Universitat Rovira i Virgili, Avinguda de la Universitat 1, 43204, Reus, Spain.
| | - Max Brosa
- Oblikue Consulting, Barcelona, SL, Spain.
| | - Juan Carlos Souto
- Unitat d'Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | | | - Gordon Guyatt
- Department of Clinical Epidemiology & Biostatistics, CLARITY Research Group, McMaster University Medical Centre 2C9, 1200 Main St W, Hamilton, ON, Canada.
| | - Pablo Alonso-Coello
- Department of Clinical Epidemiology & Biostatistics, CLARITY Research Group, McMaster University Medical Centre 2C9, 1200 Main St W, Hamilton, ON, Canada.
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau) Research, CIBER of Epidemiology and Public Health (CIBERESP), Sant Antoni M. Claret 167, 08025, Barcelona, Spain.
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Ferrando F, Mira Y. Effective and Safe Management of Oral Anticoagulation Therapy in Patients Who Use the Internet-Accessed Telecontrol Tool SintromacWeb. Interact J Med Res 2015; 4:e10. [PMID: 25900775 PMCID: PMC4420842 DOI: 10.2196/ijmr.3610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/24/2014] [Accepted: 02/19/2015] [Indexed: 01/04/2023] Open
Abstract
Background Despite the existing evidence that highlights the benefits of oral anticoagulation therapy (OAT) self-testing and self-management by patients in comparison with conventional control, significant progress is still needed in the implementation of computer-based, Internet-assisted systems for OAT within health care centers. The telecontrol tool “SintromacWeb” is a previously validated system for OAT management at home, which is currently operative and accessed by patients through a hospital Web portal. Objective The intent of the study was to assess the effectiveness and safety of OAT management in patients using the SintromacWeb telecontrol system in reference to control in patients using the conventional system (management at the hematology department), in terms of time in therapeutic range (TTR) of International Normalized Ratio (INR). Methods In this observational prospective study, patients were identified by their physician and divided in two groups according to the OAT management system that they were already using (conventional control or telecontrol with SintromacWeb). For 6 months, patients were required to visit the hematology department every time their physician considered it necessary according to usual clinical practice. Sociodemographic and clinical variables for the study were collected at first visit (baseline) and at those visits closest to 2, 4, and 6 months after first visit. Results A total of 173 patients were evaluated, 87 with conventional control and 86 with telecontrol. Follow-up time was a median of 6.3 (range 5.2-8.1) months. The average time of OAT treatment prior to enrollment was 9.2 (SD 6.4) years. Patients in the telecontrol group tested their INR a median of 21 (range 4-22) days versus a median of 35 (range 14-45) days in patients in the conventional control group (P<.001). TTR in the telecontrol group was 107 (SD 37) days versus 94 (SD 37) days in the conventional control group (an increase of 12.6%; P=.02). In all visits, the percentage of TTR was higher in the telecontrol group (at the third visit: 59% vs 48%; P=.01). Higher TTR (positive coefficient) was associated with patients under OAT telecontrol (P=.03). Under-anticoagulation (INR<1.5) and over-anticoagulation (INR>5) were observed in 34 (19.7%, 34/173) and 38 (22.0%, 38/173) patients, respectively (no differences between treatment groups). Seven thrombotic and/or bleeding events were serious, 12 were non-serious, and most of them (5 and 10, respectively) occurred in the conventional control group. Conclusions In clinical practice, OAT management with the Internet-based tool SintromacWeb is effective and safe for those patients who are eligible for OAT telecontrol.
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Affiliation(s)
- Fernando Ferrando
- Hospital Universitari i Politècnic La Fe, Unidad de Hemostasia y Trombosis, Valencia, Spain.
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Correa Rodas M, Naranjo Hurtado C, Ramírez Carmona LX, Restrepo Correa AM, Turizo Mejia JJ, Velásquez Ruiz AF, Barragán FJ. Prácticas de prescripción y conocimientos médicos acerca de los anticoagulantes orales directos en un hospital de referencia. IATREIA 2015. [DOI: 10.17533/udea.iatreia.v28n2a05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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de Andrés-Nogales F, Oyagüez I, Betegón-Nicolás L, Canal-Fontcuberta C, Soto-Álvarez J. Status of oral anticoagulant treatment in patients with nonvalvular atrial fibrillation in Spain. REACT-AF study. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2014.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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de Andrés-Nogales F, Oyagüez I, Betegón-Nicolás L, Canal-Fontcuberta C, Soto-Álvarez J. Situación del tratamiento anticoagulante oral en pacientes con fibrilación auricular no valvular en España. Estudio REACT-AF. Rev Clin Esp 2015; 215:73-82. [DOI: 10.1016/j.rce.2014.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/23/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
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Sabaté M, Brugaletta S, Abizaid A, Banning A, Bartorelli A, Džavík V, Ellis S, Holmes D, Gao R, Jeong MH, Legrand V, Neumann FJ, Nyakern M, Spaulding C, Stoll HP, Worthley S, Urban P. Drug eluting stent implantation in patients requiring concomitant vitamin K antagonist therapy. One-year outcome of the worldwide e-SELECT registry. Int J Cardiol 2013; 168:2522-7. [PMID: 23602865 DOI: 10.1016/j.ijcard.2013.03.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 02/05/2013] [Accepted: 03/17/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Outcome of sirolimus-eluting stent (SES) in patients treated with an antivitamin K (VKA) agent before the PCI procedure is unknown. METHODS A total of 7651 patients were selected among 15,147 recipients of SES, included in the worldwide e-SELECT registry, only from those centers which included at least one patient requiring VKA: 296 were pretreated with a VKA agent (VKA group), whereas 7355 patients from the same enrolling medical centers were not (NON-VKA group). The rates of 1) major adverse cardiac events (MACE), including all-cause deaths, myocardial infarction (MI) and target lesion revascularization, 2) stent thrombosis (ST) and 3) major bleeding (MB) in the 2 study groups were compared at 1, 6 and 12 months. RESULTS The patients in VKA group were on average older as compared to those in NON-VKA group (67.7 ± 9.9 vs.62.9 ± 10.7, P<0.001). The indications for pre-procedural anticoagulation were atrial fibrillation in 177 (59.8%), presence of a prosthetic valve in 21 (7.1%), embolization of cardiac origin in 17 (5.7%), pulmonary embolism or deep vein thrombosis in 17 (5.7%), and miscellaneous diagnoses in 64 (21.6%) patients. At 1 year, the rates of MACE and MB were higher in the VKA vs. the NON-VKA group (8.3% and 3% vs. 5.3% and 1.2%, P<0.04 and P<0.002, respectively). The 1-year rates of definite and probable ST were remarkably low in both groups (0.38% vs. 1.1%, p=0.4). CONCLUSIONS Selected patients anticoagulated with VKA agent may safely undergo SES implantation. Those patients may receive a variety of APT regimen at the cost of a moderate increased risk of MB.
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González-Juanatey JR, Álvarez-Sabin J, Lobos JM, Martínez-Rubio A, Reverter JC, Oyagüez I, González-Rojas N, Becerra V. Cost-effectiveness of dabigatran for stroke prevention in non-valvular atrial fibrillation in Spain. Rev Esp Cardiol 2012; 65:901-10. [PMID: 22958943 DOI: 10.1016/j.recesp.2012.06.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 06/06/2012] [Indexed: 01/22/2023]
Abstract
INTRODUCTION AND OBJECTIVES Assessment of the cost-effectiveness of dabigatran for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation in Spain, from the perspective of the National Health System. METHODS Adaptation of a Markov chain model that simulates the natural history of the disease over the lifetime of a cohort of 10,000 patients with non-valvular atrial fibrillation. Model comparators were warfarin in a first scenario, and a real world prescribing pattern in a second scenario, in which 60% of the patients were treated with vitamin K antagonists, 30% with acetylsalicylic acid, and 10% received no treatment. Deterministic and probabilistic sensitivity analyses were performed. RESULTS Dabigatran reduced the occurrence of clinical events in both scenarios, providing gains in quantity and quality of life. The incremental cost-effectiveness ratio for dabigatran compared to warfarin was 17,581 euros/quality-adjusted life year gained and 14,118 euros/quality-adjusted life year gained when compared to the real world prescribing pattern. Efficiency in subgroups was demonstrated. When the social costs were incorporated into the analysis, dabigatran was found to be a dominant strategy (ie, more effective and less costly). The model proved to be robust. CONCLUSIONS From the perspective of the Spanish National Health System, dabigatran is an efficient strategy for the prevention of stroke in patients with non-valvular atrial fibrillation compared to warfarin and to the real-world prescribing pattern; incremental cost-effectiveness ratios were below the 30,000 euros/quality-adjusted life year threshold in both scenarios. Dabigatran would also be a dominant strategy from the societal perspective, providing society with a more effective therapy at a lower cost compared to the other 2 alternatives. Full English text available from:www.revespcardiol.org.
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Affiliation(s)
- José R González-Juanatey
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España
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López Gude MJ, Rodríguez Bezos D, Rodríguez Barrios JM. [Cost-benefit analysis of concomitant atrial fibrillation management in Spain]. GACETA SANITARIA 2009; 24:59-65. [PMID: 19931216 DOI: 10.1016/j.gaceta.2009.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 07/24/2009] [Accepted: 08/31/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Atrial fibrillation (AF) is the most common arrhythmia in clinical practice; this disorder is a risk factor for stroke and is associated with substantial morbidity and mortality. Our objective was to develop a cost-utility analysis of the different treatment alternatives in patients aged 40 years old or more with concomitant AF with valve disease in Spain, from the National Health System perspective. METHODS An economic evaluation through a Markov model with four health states (sinus rhythm, AF, dependent stroke, death) was developed to simulate the evolution of a cohort of 1,000 patients receiving each treatment alternative in addition to mitral valve surgery (drug therapy, surgical ablation and catheter ablation). The time horizon was 5 years, with a cycle length of 3 months. Data on costs and effects were obtained from the published literature and expert opinion and were discounted at 3.5%. A sensitivity analysis was developed to determine the robustness of the results. RESULTS The quality-adjusted life years (QALY) gained were 3.29, 3.89, and 3.83, respectively, for the alternatives of no ablation, surgical ablation and catheter ablation. The costs per patient were 5,770euro, 10,034euro and 11,289euro, respectively. The surgical ablation cost/QALY rate compared with no ablation was 7,145euro. Surgical ablation was dominant versus catheter ablation. The probabilistic sensitivity analysis showed that the results were robust. CONCLUSIONS Surgical ablation is a cost-effective treatment option in patients with concomitant AF, with a cost-effectiveness ratio under the efficiency threshold commonly accepted in Spain.
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Trullas-Vila JC, Bisbe-Company J, Freitas-Ramírez A, Soler-Simon S, Bisbe-Company V, Roncero-Vidal JM, Gispert-Magarolas R. Ten-year experience with acenocoumarol treatment in an ambulatory cohort of Spanish patients. J Thromb Thrombolysis 2009; 28:436-43. [DOI: 10.1007/s11239-009-0311-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 01/30/2009] [Indexed: 11/29/2022]
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Pérez-Gómez F, Bover R. [The new coagulation cascade and its possible influence on the delicate balance between thrombosis and hemorrhage]. Rev Esp Cardiol 2008; 60:1217-9. [PMID: 18082084 DOI: 10.1157/13113924] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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