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Jiang S, Lv M, Wu T, Chen W, Zhang J. A smartphone application for remote adjustment of warfarin dose: Development and usability study. Appl Nurs Res 2022; 63:151521. [PMID: 35034699 DOI: 10.1016/j.apnr.2021.151521] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/17/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
AIM The aim of this article is (a) to design and develop a smartphone app called Alfalfa that can provide remote dose adjustment (b) to evaluate its usability. BACKGROUND Patients taking warfarin need to spend substantial time, money, and energy frequently visiting the hospital in order to adjust its dose. Internet technology may be able to provide convenient dose adjustment services for these patients. METHODS We thought and discussed repeatedly about how to ensure the safety and effectiveness of remote administration of warfarin, and finally designed and developed the Alfalfa app. In addition, patients and medical practitioners were invited to participate in a system usability scale (SUS) to assess the usability of Alfalfa. RESULTS As of July 5, 2021, the number of Alfalfa accounts was 1736, including 1624 patients and 112 medical staff, and it provided a total of 12,968 remote dose adjustments. A total of 26 people participated in the questionnaire, including 15 patients and 11 medical staff. The results of SUS show that the usability score of patient terminal and medical terminal is 61.8 and 82.7, respectively. And age does not affect the usability of patient terminal. The usability of the Alfalfa app was rated similarly by younger and older adults (63.5 vs. 58.5, P = .535). CONCLUSIONS This study proves that the Alfalfa app can be used for remote management of warfarin. The usability of medical terminal is acceptable to medical practitioners, while the usability of patient terminal needs further improvement. TRIAL REGISTRATION ChiCTR1900021920.
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Affiliation(s)
- Shaojun Jiang
- Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou 350001, Fujian, China
| | - Meina Lv
- Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou 350001, Fujian, China
| | - Tingting Wu
- Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou 350001, Fujian, China
| | - Wenjun Chen
- Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou 350001, Fujian, China
| | - Jinhua Zhang
- Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou 350001, Fujian, China.
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Zawawi NA, Abdul Halim Zaki I, Ming LC, Goh HP, Zulkifly HH. Anticoagulation Control in Different Ethnic Groups Receiving Vitamin K Antagonist for Stroke Prevention in Atrial Fibrillation. Front Cardiovasc Med 2021; 8:736143. [PMID: 34869639 PMCID: PMC8635010 DOI: 10.3389/fcvm.2021.736143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/18/2021] [Indexed: 12/02/2022] Open
Abstract
Vitamin K antagonist such as warfarin reduces the risk of stroke in atrial fibrillation (AF) patients. Since warfarin has a narrow therapeutic index, its administration needs to be regularly monitored to avoid any adverse clinical outcomes such as stroke and bleeding. The quality of anticoagulation control with warfarin therapy can be measured by using time in therapeutic range (TTR). This review focuses on the prevalence of AF, quality of anticoagulation control (TTR) and adverse clinical outcome in AF patients within different ethnic groups receiving warfarin therapy for stroke prevention. A literature search was conducted in Embase and PubMed using keywords of “prevalence,” “atrial fibrillation,” “stroke prevention,” “oral anticoagulants,” “warfarin,” “ethnicities,” “race” “time in therapeutic range,” “adverse clinical outcome,” “stroke, bleeding.” Articles published by 1st February 2020 were included. Forty-one studies were included in the final review consisting of AF prevalence (n = 14 studies), time in therapeutic range (n = 18 studies), adverse clinical outcome (n = 9 studies) within different ethnic groups. Findings indicate that higher prevalence of AF but better anticoagulation control among the Whites as compared to other ethnicities. Of note, non-whites had higher risk of strokes and bleeding outcomes while on warfarin therapy. Addressing disparities in prevention and healthcare resource allocation could potentially improve AF-related outcomes in minorities.
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Affiliation(s)
- Nur Azyyati Zawawi
- Department of Pharmacy Practice, Fakulti Farmasi, Universiti Teknologi MARA (UiTM), Bandar Puncak Alam, Malaysia
| | - Izzati Abdul Halim Zaki
- Department of Pharmacy Practice, Fakulti Farmasi, Universiti Teknologi MARA (UiTM), Bandar Puncak Alam, Malaysia.,Cardiology Therapeutics Research Group, Universiti Teknologi MARA, Bandar Puncak Alam, Malaysia
| | - Long Chiau Ming
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah (PAPRSB) Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei
| | - Hui Poh Goh
- Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah (PAPRSB) Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei
| | - Hanis Hanum Zulkifly
- Department of Pharmacy Practice, Fakulti Farmasi, Universiti Teknologi MARA (UiTM), Bandar Puncak Alam, Malaysia.,Cardiology Therapeutics Research Group, Universiti Teknologi MARA, Bandar Puncak Alam, Malaysia
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Kalaria SN, Zhu H, Liu Q, Florian J, Wang Y, Schwartz J. Influence of age on the relationship between apixaban concentration and anti-factor Xa activity in older patients with non-valvular atrial fibrillation. Int J Cardiol 2021; 331:109-113. [PMID: 33529664 DOI: 10.1016/j.ijcard.2021.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/29/2020] [Accepted: 01/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Despite lower major bleeding rates associated with direct oral anticoagulants (DOACs) as compared to conventional warfarin therapy, bleeding rates remain higher in older patients compared to younger patients suggesting a potential role for DOAC measurements. The objective of this study is to examine the effect of age on the relationship between apixaban concentrations and anti-Factor Xa activity in patients with non-valvular atrial fibrillation (NVAF). METHODS This is a retrospective analysis based on a database created using data from the ARISTOTLE study. Outpatient, stable adult patients with NVAF receiving apixaban were included in this study. Data collection consisted of apixaban concentration, anti-Factor Xa activity, age, weight, creatinine, and co-medications. RESULTS The database composed of 2058 patients receiving apixaban. Distribution of race, NVAF subtype, and aspirin use was fairly similar across each age quantile. Older patients received a higher number of co-medications and received the 2.5 mg apixaban dose more often as compared to younger patients (22% vs. < 1%). Linear regression demonstrated that the unadjusted slope for apixaban concentration effect on anti-Factor Xa activity was similar across each age quantile. Although, the overall adjusted linear regression analysis demonstrated that the age by concentration interaction was statistically significant, relative differences in anti-Factor Xa activity (< 8%) were not clinically meaningful. CONCLUSION Data on apixaban concentrations and anti-Factor Xa activity from a pivotal randomized double-blind study of apixaban for the prevention of stroke in NVAF patients have confirmed that the chromogenic anti-Factor Xa activity assay can accurately assess apixaban concentrations in patients regardless of age. Age was not associated with a clinically relevant change in the apixaban vs. anti-Factor Xa activity response relationship and target ranges are unchanged.
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Affiliation(s)
- Shamir N Kalaria
- Center for Translational Medicine, University of Maryland, School of Pharmacy, Baltimore, MD, United States of America
| | - Hao Zhu
- Office of Clinical Pharmacology, US Food and Drug Administration, White Oak, MD, United States of America
| | - Qi Liu
- Office of Clinical Pharmacology, US Food and Drug Administration, White Oak, MD, United States of America
| | - Jeffrey Florian
- Office of Clinical Pharmacology, US Food and Drug Administration, White Oak, MD, United States of America
| | - Yaning Wang
- Office of Clinical Pharmacology, US Food and Drug Administration, White Oak, MD, United States of America
| | - Janice Schwartz
- Department of Medicine, University of California San Francisco, School of Medicine, San Francisco, CA, United States of America.
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Tiili P, Putaala J, Mehtälä J, Khanfir H, Niiranen J, Korhonen P, Raatikainen P, Lehto M. Poor Quality of Warfarin Treatment Increases the Risk of All Types of Intracranial Hemorrhage in Atrial Fibrillation. Circ J 2019; 83:540-547. [DOI: 10.1253/circj.cj-18-0975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Paula Tiili
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki
| | | | | | - Jussi Niiranen
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki
| | | | - Pekka Raatikainen
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki
| | - Mika Lehto
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki
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Long-Term Statin Administration Does Not Affect Warfarin Time in Therapeutic Range in Australia or Singapore. J Clin Med 2018; 7:jcm7050097. [PMID: 29723987 PMCID: PMC5977136 DOI: 10.3390/jcm7050097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 04/24/2018] [Accepted: 04/26/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Warfarin requires ongoing monitoring of the International Normalised Ratio (INR). This is because numerous factors influence the response, including drug interactions with commonly-prescribed medications, such as statins. The administration of statins with warfarin may change INR; however, there is limited information regarding the effects on warfarin control as measured by time in therapeutic range (TTR). Statins may also alter bleeds with warfarin, but there are conflicting reports demonstrating both increased and decreased bleeds, and limited data on diverse ethnic populations. Therefore, the aim of this study was to determine the effect of statin administration on warfarin control and bleeds in patients in Australia and Singapore. METHODS Retrospective data were collected for patients on warfarin between January and June 2014 in Australia and Singapore. Patient data were used to calculate TTR and bleed events. Concurrent statin therapy was assessed and comparisons of TTR and bleed incidence were made across patient subgroups. RESULTS Warfarin control in Australia and Singapore was not significantly affected by statins, as measured by TTR (83% and 58%, respectively), frequency of testing, and warfarin doses. In Australia, statin use did not significantly affect bleeds, whilst in Singapore the bleed incidence was significantly lower for patients on statins. CONCLUSIONS Chronic concurrent administration of statins with warfarin does not adversely affect warfarin TTR in Australia or Singapore. In Singapore, patients on statins, compared to no statins, had a lower bleed incidence and this requires further investigation, especially given the potential genetic influences of ethnicity on both statin and warfarin metabolism.
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Ortiz M, Llamas P, Sanmartín M, Egido J, del Toro J, Egocheaga M, Estévez M, Navarro I, Mira J. Unnecessary overuse. Study of “inadvisable practices” for patients with atrial fibrillation. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Faircloth JM, Miner KM, Alsaied T, Nelson N, Ciambarella J, Mizuno T, Palumbo JS, Vinks AA, Veldtman GR. Time in therapeutic range as a marker for thrombotic and bleeding outcomes in Fontan patients. J Thromb Thrombolysis 2017; 44:38-47. [DOI: 10.1007/s11239-017-1499-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ortiz MM, Llamas P, Sanmartín M, Egido JA, Del Toro J, Egocheaga MI, Estévez MS, Navarro IM, Mira JJ. Unnecessary overuse. Study of "inadvisable practices" for patients with atrial fibrillation. Rev Clin Esp 2017; 217:181-187. [PMID: 28363610 DOI: 10.1016/j.rce.2017.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/07/2017] [Accepted: 02/20/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To identify overuse (diagnostic, therapeutic and self-care practices that represent risks that outweigh the potential benefits) in patients with atrial fibrillation. METHOD The study was based on qualitative research techniques. Using the "Metaplan" technique, we identified and ordered potentially inappropriate, ineffective and inefficient practices. By means of a consensus conference, we then established a number of "inadvisable practice" measures (relatively common practices that should be eliminated based on the scientific evidence or clinical experience). Professionals from the specialties of cardiology, haematology, neurology, internal medicine, family medicine and nursing participated in the consensus. RESULTS We developed a catalogue of 19 "inadvisable practices" related to the diagnosis, treatment and care of anticoagulated patients that were inappropriate, had questionable effectiveness or were ineffective, as well as 13 beliefs or behaviours for anticoagulated patients that could result in injury or were useless or inefficient. CONCLUSION The "inadvisable practices" approach helps identify practices that represent greater risks than benefits for patients. It seems appropriate to include algorithms in the clinical decision-making support systems that consider this information for the diagnosis, treatment and for home care. For this last case, recommendations have also been prepared that define specific contents for the healthcare education of these patients.
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Affiliation(s)
- M M Ortiz
- Unidad de Calidad, Hospital Universitario de Fuenlabrada, Madrid, España; Asociación Madrileña de Calidad Asistencial, Madrid, España
| | - P Llamas
- Hematología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - M Sanmartín
- Cardiología, Hospital Ramón y Cajal, Madrid, España
| | - J A Egido
- Neurología, Hospital Clínico San Carlos, Madrid, España
| | - J Del Toro
- Medicina Interna, Hospital Gregorio Marañón, Madrid, España
| | - M I Egocheaga
- Medicina de Familia, Centro de Salud Isla de Oza, Madrid, España
| | - M S Estévez
- Enfermería, Hospital Universitario Fundación Alcorcón, Madrid, España
| | - I M Navarro
- Universidad Miguel Hernández de Elche, Alicante, España.
| | - J J Mira
- Universidad Miguel Hernández de Elche, Alicante, España; Departamento de Salud Alicante-Sant Joan, Alicante, España; REDISSEC Red Enfermedades crónicas, Madrid, España
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Abstract
Anticoagulants are beneficial for prevention and treatment of venous thromboembolism and stroke prevention in atrial fibrillation. The development of target-specific oral anticoagulants is changing the landscape of anticoagulation therapy and created growing interest on this subject. Understanding the pharmacology of different anticoagulants is the first step to adequately treat patients with best available therapy while avoiding serious bleeding complications. This article reviews the pharmacology of the main anticoagulant classes (vitamin K antagonists, direct oral anticoagulants, and heparins) and their clinical indications based on evidence-based data currently available in the literature.
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Affiliation(s)
- Joana Lima Ferreira
- Division of General Internal Medicine, Department of Medicine, University of Washington Medical Center, 1959 North East Pacific Street, Box 356429, Seattle, WA 98195, USA.
| | - Joyce E Wipf
- Department of Medicine, Center of Excellence in Primary Care Education, Seattle VA Puget Sound Health Care System, University of Washington, 1660 South Columbian Way (S-123-CoE), Seattle, WA 98108, USA
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