Initiation of Warfarin Treatment in Outpatients with Nonrheumatic Atrial Fibrillation: A Scheme for Early Indication of Maintenance Dose

Pengo, Vittorio; Zasso, A; Barbero, Fabio; Biasiolo, A; Rampazzo, Patrizia; Brocco, T.

doi:10.1177/107602969800400411

Cited by 6 publications

(3 citation statements)

References 17 publications

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“…Patients may not take dosages appropriately after discharge and may not understand instructions appropriately. The initiation of warfarin is traditionally difficult despite the presence of a number of management protocols [10–12]. The trend to early discharge of patients with embolic disorders after the initiation of warfarin makes the transfer of information to general practitioners (GPs) very important.…”

Section: Introductionmentioning

confidence: 99%

Improving the outcomes of anticoagulation: an evaluation of home follow‐up of warfarin initiation

Jackson¹,

Peterson²,

Vial

et al. 2004

Journal of Internal Medicine

106

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Objectives. A number of studies have reported that the risk of bleeding associated with warfarin is highest early in the course of therapy. This study examined the effect of a programme focused on the transition of newly anticoagulated patients from hospital to the community. Design. Open-label randomized controlled trial. Setting. Home-based follow-up of patients discharged from acute care hospital in southern Tasmania, Australia. Subjects. A total of 128 patients initiated on warfarin in hospital and subsequently discharged to general practitioner (GP) care were enrolled in the study. Sixty were randomized to home monitoring (HM) and 68 received usual care (UC). Interventions. HM patients received a home-visit by the project pharmacist and point-of-care international normalized ratio (INR) testing on alternate days on 4 occasions, with the initial visit two days after discharge. The UC group was solely managed by the GP and only received a visit 8 days after discharge to determine anticoagulant control. Results. At discharge, 42% of the HM group and 45% of the UC group had a therapeutic INR. At day 8, 67% of the HM patients had a therapeutic INR, compared with 42% of UC patients (P < 0.002). In addition, 26% of UC patients had a high INR, compared with only 4% of HM patients. Bleeding events were assessed 3 months after discharge and occurred in 15% of HM patients, compared with 36% of the UC group (P < 0.01).Conclusions. This programme improved the initiation of warfarin therapy and resulted in a significant decrease in haemorrhagic complications in the first 3 months of therapy.

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Section: Introductionmentioning

confidence: 99%

Improving the outcomes of anticoagulation: an evaluation of home follow‐up of warfarin initiation

Jackson¹,

Peterson²,

Vial

et al. 2004

Journal of Internal Medicine

106

View full text Add to dashboard Cite

show abstract

“…On a previous observation, we found that a 10-mg protocol for 2 consecutive days resulted in excessive anticoagulation by day 3, especially in elderly patients. 25 We therefore switched to a 5-mg protocol for 4 days that resulted in a more gradual increase of the INR values. Interestingly, we found a correlation between the INR achieved on day 5 and the expected maintenance dose.…”

Section: Initiation Of Anticoagulation (How We Start Treatment With Warfarin)mentioning

confidence: 99%

Optimizing quality care for the oral vitamin K antagonists (VKAs)

Pengo

Denas

2018

Hematology

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Vitamin K antagonists (VKAs) have been the only oral anticoagulants for decades. The management of anticoagulant therapy with VKA is challenging because of the intricate pharmacological properties of these agents. The success of VKA therapy depends on the quality of treatment that is ensured through continuing comprehensive communication and education. The educational program should address important issues of the VKA therapy such as beginning of treatment, pharmacological, dietary, and drug–drug interactions, as well as treatment temporary suspension during surgical interventions or invasive maneuvers. In addition, the initial and continuing patient education is of imperative importance. A major role in the educational process may be addressed by patient associations. The quality of treatment is better reached if patients are followed in anticoagulation clinics. Moreover, a federation of anticoagulation clinics may improve patient care through regular meetings to update knowledge on VKA treatment. Learning objectives of this paper is to allow readers to correctly approach patients starting VKA treatment, recognize possible pitfalls of treatment, and provide adequate solutions.

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“…2,3 Reports also indicate that the quality of initiation of anticoagulation in the hospital setting may be less than optimal. 4,5 Initiating warfarin is complex as it is influenced by many factors, such as underlying warfarin sensitivities, differences in vitamin K status, concomitant medications and disease states, and warfarin's delayed action. An early elevation in the international normalised ratio (INR) may not accurately reflect the antithrombotic effects of warfarin given the difference in half-lives of the vitamin K-dependent clotting factors.…”

Section: Introductionmentioning

confidence: 99%

Improving Clinical Outcomes for Hospital Patients Initiated on Warfarin

Bereznicki¹,

Jackson²,

Morgan

et al. 2007

Pharmacy Practice and Res

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Background: Studies have demonstrated that the risk of warfarin-related complications is highest in the first 90 days of treatment, while quality audits suggest that warfarin initiation protocols are not always adhered to. Aim: To improve the quality of anticoagulation for hospital patients initiated on warfarin. Method: A warfarin drug chart, incorporating the hospital's warfarin initiation protocol, was implemented on four target medical and cardiothoracic wards. The chart was used to record international normalised ratios (INRs) and prescribe warfarin, and was faxed to the patient's GP on discharge. Warfarin initiations on the target wards immediately postintroduction of the warfarin drug chart were reviewed and compared to the pre-intervention data collected over a 17-month period. Results: The pre-intervention and post-intervention groups included 271 and 183 patients initiated on warfarin, respectively. The intervention was associated with fewer warfarin-related complications (thromboembolism, major bleeding) occurring within a 90-day follow-up period (2.1% vs 11%; adjusted OR 0.24; 95%CI 0.07-0.85; p = 0.03), largely driven by a reduction in the incidence of major bleeding (0.7% vs 7.1%; adjusted OR 0.17; 95%CI 0.02-1.45; p = 0.05). Adherence to the warfarin initiation protocol improved significantly from 36% to 71% (p < 0.01) in the pre-and post-intervention data collection periods, respectively. Post-intervention, the proportion of patients with an INR > 4 and the proportion of patients who required a warfarin dose to be withheld was reduced from 8.5% and 13%, to 3.8% (p < 0.05) and 6.6% (p = 0.02), respectively. Conclusion: Adherence to an age and disease based warfarin initiation protocol, and improving the quality of discharge information for patients initiated on warfarin, significantly improved patient outcomes. J Pharm Pract Res 2007; 37: 295-7, 300-2.

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Initiation of Warfarin Treatment in Outpatients with Nonrheumatic Atrial Fibrillation: A Scheme for Early Indication of Maintenance Dose

Cited by 6 publications

References 17 publications

Improving the outcomes of anticoagulation: an evaluation of home follow‐up of warfarin initiation

Improving the outcomes of anticoagulation: an evaluation of home follow‐up of warfarin initiation

Optimizing quality care for the oral vitamin K antagonists (VKAs)

Improving Clinical Outcomes for Hospital Patients Initiated on Warfarin

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