Adherence to guidelines for the management of excessive warfarin anticoagulation

Devine, Emily Beth; Hopefl, Alan W.; Wittkowsky, Ann K.

doi:10.1007/s11239-008-0232-z

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…Study designs included 14 retrospective record reviews [ 20 21 22 23 24 25 26 27 28 29 30 31 32 33 ], 6 cohort studies [ 34 35 36 37 38 39 ] and 1 a case-control [ 40 ] (see Table 1 ). Four studies focused on overuse, 5on underuse, and 12 on both.…”

Section: Resultsmentioning

confidence: 99%

“…Large variation in the rates of antithrombotic overuse was observed across geographic regions with studies from Asia reporting the lowest levels of overuse (1.3–7.6%) [ 27 33 ], followed by Australia (24.1–42.9%) [ 20 23 24 ], and Europe (1.4–72.0%) [ 21 25 28 29 30 33 36 37 38 39 40 ], through to the highest variation in North America (6.6–73.0%) [ 26 31 32 34 35 ]. No clear time trend of increasing or decreasing overuse was observed over the period of the studies (2008–2020).…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

“…Among the three studies of perioperative bridging anticoagulation reporting overuse, estimates varied from 21% in a Polish cohort of patients with AF undergoing percutaneous coronary intervention [ 39 ], through to 34% in a retrospective review of Dutch patients receiving Vit K antagonists before acute or elective surgeries [ 21 ], and up to 59.6% of French patients in people undergoing elective or emergency procedures [ 29 ]. A North American cohort study of patients presenting with prolonged prothrombin time INR ≥4.5 reported as 22.3% due to unjustified administration route or excess dose [ 35 ]. Median overuse across these studies was 34% (IQR 27.5 – 46.8%).…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

“…Underuse of bridging coagulation in the perioperative period was found to be present in 33.0% cases in a Canadian hospital cohort [ 34 ] and wide variation between 9.0 and 50.0% was found in Europe across three retrospective hospital audits [ 21 29 30 ] and one hospital cohort [ 39 ]. A US cohort of patients presenting with excess coagulation found 6.2% under-administration of vitamin K [ 35 ], and a retrospective analysis of management or traumatic injuries to prevent coagulopathy and thromboembolic events in a French hospital reported 14.3% underprescribing of thrombolytic agents [ 28 ]. Median underuse in perioperative bridging across the five studies was 25.0% (IQR 13.1 – 32.0%).…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

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Guideline Adherence As An Indicator of the Extent of Antithrombotic Overuse and Underuse: A Systematic Review

Cardona

Craig

Jones

et al. 2022

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Thromboembolic events are a common risk in adults with atrial fibrillation, those with previous cerebrovascular accidents and undergoing emergency or elective surgeries. The widespread availability of antithrombotic agents and differing guidelines contribute to practice variations and increased risk of complications and deaths. The objective of this review was to investigate the extent of overuse and underuse of antithrombotics for primary or secondary prevention as measured by deviation from prescribing guideline recommendations. We conducted a systematic review of Medline and EMBASE for quantitative articles published between 2000 and 2021 and used a modified version of the Hoy's risk of bias assessment tool. Here we report evidence from the past decade about wide practice variations in hospitals and primary care, and discuss clinician and patient-driven determinants of non-adherence to guidelines. Finally, we summarise implications for practice, identify enhanced ways of measuring overuse and underuse, and propose potential solutions to the measurement challenges. 2 Cardona et al.

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Section: Resultsmentioning

confidence: 99%

Section: Synthesis Of Resultsmentioning

confidence: 99%

Section: Synthesis Of Resultsmentioning

confidence: 99%

Section: Synthesis Of Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Guideline Adherence As An Indicator of the Extent of Antithrombotic Overuse and Underuse: A Systematic Review

Cardona

Craig

Jones

et al. 2022

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“…Standard guidelines exist on managing patients who are excessively anticoagulated [6]. However, adherence to these guidelines is variable [7].…”

Section: Discussionmentioning

confidence: 99%

An Audit of Management of Patients on Oral Anticoagulant Therapy With International Normalized Ratio (INR) Five or Above

Chopra

Kakkar

2012

Indian J Hematol Blood Transfus

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Maintaining the international normalized ratio (INR) within the therapeutic range in patients on oral anticoagulant treatment is a challenge for the physician. Excessive anticoagulation poses the risk of bleeding in patients. Management strategies vary among clinicians although standard guidelines exist for the same. We conducted an audit in patients on oral anticoagulant therapy in our hospital with excessive anticoagulation. This retrospective study was carried out among patients on oral anticoagulant therapy for various thrombotic conditions with at least a single INR recording of 5 or more. Other than demographic details, the type of oral anticoagulant used, indication, duration of treatment, dosage and concomitant use of interacting drugs or alcohol were also recorded. Detail of the nature and site of bleed and management for the same was also noted. Data were analyzed using descriptive statistics. Fifty episodes with INR C 5 (5.0-10.75) were noted in 44 patients (M:F = 1:1). Their age ranged from 20 to 88 years (mean 50.3 ± 16.4 years). The duration of anticoagulant therapy varied from 3 days to 180 months. Of the 43 episodes in patients who had no bleeding, the anticoagulant was stopped on 32 occasions for variable periods with dose reduction in the rest of the patients. Spontaneous bleeding was seen in seven patients (6 major and 1 minor). Among the seven patients with bleeding, other than stopping he oral anticoagulant drug, other measures taken were vitamin K therapy, fresh frozen plasma or packed red cell transfusion. Overall management strategy of patients with high INR was in compliance with standard recommendations.

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Thromboprophylaxis After Major Orthopaedic Surgery: State of the Art

Turpie

2009

European Instructional Lectures

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Adherence to guidelines for the management of excessive warfarin anticoagulation

Abstract: Adherence to the ACCP guidelines is low. Inappropriate use of vitamin K1 is the primary reason.

Cited by 8 publications

References 24 publications

Guideline Adherence As An Indicator of the Extent of Antithrombotic Overuse and Underuse: A Systematic Review

Guideline Adherence As An Indicator of the Extent of Antithrombotic Overuse and Underuse: A Systematic Review

An Audit of Management of Patients on Oral Anticoagulant Therapy With International Normalized Ratio (INR) Five or Above

Thromboprophylaxis After Major Orthopaedic Surgery: State of the Art

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