Management patterns and outcomes of patients with venous thromboembolism in the usual community practice setting

Willey, Vincent J.; Bullano, Michael F.; Hauch, Ole; Reynolds, Matthew W.; Wygant, Gail; Hoffman, Lauren A.; Mayzell, George; Spyropoulos, Alex C.

doi:10.1016/s0149-2918(04)90187-7

Cited by 70 publications

(59 citation statements)

References 41 publications

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“…[15][16][17][18][19][20][21][22][23][24][25][26][27][28] Our updated systematic search from January 2005 through February 2008 (as depicted in Figure 1) identified an additional 536 studies for full text review, of which 526 were excluded. Of the studies excluded, most were excluded because they were not conducted in the United States, or they were not a primary study.…”

Section: ■■ Resultsmentioning

confidence: 99%

“…Of these, 16 studies were excluded because patients were included for indications other than AF. 14,15,19,[22][23][24][25][27][28][29][30][32][33][34]36,37 Thus, 8 studies, including a total of 14 study groups, met all of the inclusion criteria and were included in the final analysis (Table 1). 17,18,20,21,26,31,35,38 The study groups enrolled a median of 317 patients (interquartile range, 150 to 482 patients; total = 22,237 warfarintreated patients), 31 who were followed for a median of 272.3 patient-years (range, 123.9 to 980.8 patient-years; total = 41,471.9 patient-years).…”

Section: ■■ Resultsmentioning

confidence: 99%

“…Gadisseur et al (2003) in a randomized trial found that patient self-management using a hand-held prothrombin time monitoring device was at least as effective as specialized physician management in anticoagulation clinics, as measured by the proportion of time spent in INR range. 9 In the systematic review and meta-regression reported by van Walraven et al, 24.4% of the patients were managed in usual care (community physicians); 68.3% of patients were in anticoagulation clinics; and 7.3% of the patients were involved in clinical trials. 8 Metaregression showed that setting had a significant effect on anticoagulation control, with studies in community practices having significantly lower control than either anticoagulation clinics or clinical trials (-12.2%; 95% CI = -19.5 to -4.8; P < 0.001), and self-management was associated with a significant improvement of time spent in the therapeutic range (+ 7.0%; 95% CI = 0.7-13.3; P = 0.03).…”

Section: What Is Already Known About This Subjectmentioning

confidence: 99%

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Meta-Analysis to Assess the Quality of Warfarin Control in Atrial Fibrillation Patients in the United States

Baker

Cios²,

Sander³

et al. 2009

JMCP

368

223

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BACKGROUND: Atrial fibrillation (AF) affects a significant proportion of the American population and increases ischemic stroke risk by 4-to 5-fold. Oral vitamin K antagonists, such as warfarin, can significantly reduce this stroke risk but can be difficult to dose and monitor. Previous research on the effects of setting (e.g., randomized controlled trials, anticoagulation management by specialty clinics, usual care by community physicians) on the proportion of time spent within therapeutic range for the international normalized ratio (INR) has not specifically examined anticoagulation in AF patients.OBJECTIVES: Use traditional meta-analytic and meta-regressive techniques to evaluate the effect of specialty clinic versus usual care by community physicians on anticoagulation control, measured as the proportion of time spent in therapeutic INR range, for AF patients that received warfarin anticoagulation in the United States.METHODS: Studies included in a previously published meta-analysis (van Walraven et al., 2006), which systematically searched reports between 1987 and 2005, were also screened for inclusion in our analysis. A subsequent systematic literature search of MEDLINE, EMBASE, and the Cochrane Central Register of Clinical Trials from January 2005 through February 2008 was conducted. Studies were included if they (a) contained at least 1 warfarin-treated group including more than 25 patients for whom INR control was monitored for at least 3 weeks; (b) included patients treated for AF in the United States; (c) used a patient-time approach (patient-year) to report outcomes; and (d) reported data on the proportion of time spent in traditional therapeutic INR ranges (i.e., a lower limit INR between 1.8 and 2.0 and an upper limit INR between 3.0 and 3.5. Studies with INR goals outside this range were excluded). The proportion of time spent within the therapeutic INR range for each study group was expressed as an incidence density using a person-time approach (in years). All studies were pooled using a random effects model and were weighted by the inverse of the variance of proportion of time spent in the therapeutic range. In order to determine how study setting influenced the proportion of time spent within a therapeutic INR range, both subgroup and meta-regression analyses were conducted.RESULTS: This analysis included 8 studies and a total of 14 unique warfarin-treated groups; 3 of the 8 studies and 4 of the warfarin groups were not included in the previous meta-analysis (van Walraven et al., 2006). Overall, patients spent a mean 55% (95% CI = 51%-58%) of their time in the therapeutic INR range. Meta-regression suggested that AF patients treated in a community usual care setting compared with an anticoagulation clinic spent 11% (95% CI = 2%-20%, n = 6 studies with 9 study groups) less time in range.CONCLUSIONS: In the United States, AF patients spend only about one-half the time within therapeutic INR. Anticoagulation clinic services are associated with somewhat better INR control compared with stan...

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Section: ■■ Resultsmentioning

confidence: 99%

Section: ■■ Resultsmentioning

confidence: 99%

Section: What Is Already Known About This Subjectmentioning

confidence: 99%

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Meta-Analysis to Assess the Quality of Warfarin Control in Atrial Fibrillation Patients in the United States

Baker

Cios²,

Sander³

et al. 2009

JMCP

368

223

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show abstract

“…Anticoagulation management service (AMS) has been established several decades to ease heavy burden for primary physicians in oral anticoagulation therapy. It has been reported that patients managed by AMS or anticoagulation clinic (AC) had better treatment results, especially lower major bleeding rates than personal physician management (6)(7)(8)(9). In addition, several studies reported significant improvements in haemorrhage and thrombosis events with patients in AMS (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Pharmacist-led Anticoagulation Management on Clinical Outcomes: A Systematic Review and Meta-Analysis

Hou

Yang

et al. 2017

J Pharm Pharm Sci

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-OBJECTIVES:We performed this systematic review and meta-analysis to confirm whether patients benefit more from pharmacist-led anticoagulation management than other models. METHODS: We searched PubMed, Embase, Cochrane Library and reference lists of yielded results conducted up to April 25, 2017. RCTs and observational cohort studies and case-control studies which compared the percentage of time within the target therapeutic range (TTR), the percentage of time within the expanded therapeutic range (TER), haemorrhage events, thrombosis events, mortality, patient satisfaction and/or medicine cost saving of pharmacist-led anticoagulation management with other models, and species were limited to humans. Two investigators evaluated methodology and extracted data from included studies independently. Data analysis were performed by STATA 12.0 software and quality of evidence assessment was performed by GRADEprofiler software. RESULTS: 8 RCTs and 9 observational cohort studies with 9919 patients were included eventually with high quality and no publication bias. In RCTs pooled results, TTR (p=0.548 moderate-quality), TER (p=0.285, moderate-quality), total haemorrhage events (p=0.140, low-quality), minor haemorrhage events (p=0.162, low-quality), major haemorrhage events (p=0.237, low-quality), thrombosis events (p=0.615, low-quality) and mortality (p=0.876, low-quality) was not significant between two groups.

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“…In real-world ! 2015 Taylor & Francis www.cmrojournal.com practice, the proportion of anticoagulated patients who are commonly found within the therapeutic range is lower than 40%, this proportion increasing up to 60% in the framework of randomized clinical trials 18 . Based on the results from a meta-analysis of 18 randomized trials including 101,801 patients, the rate of adherence and discontinuation of patients assigned to NOAC agents was found to be similar to that of patients allocated to warfarin for each of the investigated compounds 19 .…”

mentioning

confidence: 99%

Adherence to the novel oral anticoagulants: an unmet need

Prandoni

2015

Current Medical Research and Opinion

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Management patterns and outcomes of patients with venous thromboembolism in the usual community practice setting

Cited by 70 publications

References 41 publications

Meta-Analysis to Assess the Quality of Warfarin Control in Atrial Fibrillation Patients in the United States

Meta-Analysis to Assess the Quality of Warfarin Control in Atrial Fibrillation Patients in the United States

Effectiveness of Pharmacist-led Anticoagulation Management on Clinical Outcomes: A Systematic Review and Meta-Analysis

Adherence to the novel oral anticoagulants: an unmet need

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