Outcomes and predictors of very stable INR control during chronic anticoagulation therapy

Witt, Daniel M.; Delate, Thomas; Clark, Nathan P.; Martell, Chad W.; Tran, Tomio; Crowther, Mark; García, David; Ageno, Walter; Hylek, Elaine M.

doi:10.1182/blood-2009-02-207928

Cited by 109 publications

(78 citation statements)

References 21 publications

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“…Demographic and health insurance plan characteristics such as age, gender, U.S. geographic region of residence, health plan type, and enrollment status are available in the files. Detailed health care encounters of both inpatient and outpatient care are recorded in the medical services claims, which include date and place of service(s), provider type, payments, and up to 15 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis and procedure codes. Pharmacy claims contain information on filled prescriptions, including National Drug Code, prescription fill dates, quantity dispensed, days supply, and plan-and patient-paid costs.…”

Section: ■■ Methods Data Sourcementioning

confidence: 99%

“…Out-of-range INRs are burdensome, carrying the potential for miscalculated dose adjustments, requiring careful monitoring of the patient, and often necessitating additional clinical visits and blood tests. 15 Excessive fluctuations in INR, as well as any bleeding events that may result, are factors associated with discontinuation of warfarin therapy. 16 Unfortunately, the administrative claims data used in this study do not allow us to determine whether INRs for these patients were well controlled.…”

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confidence: 99%

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One-Year Adherence to Warfarin Treatment for Venous Thromboembolism in High-Risk Patients and Its Association with Long-term Risk of Recurrent Events

Chen¹,

Wu²,

Gulseth³

et al. 2013

JMCP

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Section: ■■ Methods Data Sourcementioning

confidence: 99%

mentioning

confidence: 99%

One-Year Adherence to Warfarin Treatment for Venous Thromboembolism in High-Risk Patients and Its Association with Long-term Risk of Recurrent Events

Chen¹,

Wu²,

Gulseth³

et al. 2013

JMCP

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“…15 This reduced INR monitoring frequency for selected patients further reduces the perceived inconvenience of warfarin treatment.…”

Section: Selection Of Patient Groups For Warfarin or The New Anticoagmentioning

confidence: 99%

How I treat with anticoagulants in 2012: new and old anticoagulants, and when and how to switch

Schulman

Crowther

2012

Blood

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226

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Two novel oral anticoagulants, dabigatran and rivaroxaban, have recently been approved. They differ in many ways from warfarin, including rapid onset of action, shorter half-life, fewer drug-drug interactions, lack of need for monitoring, and no need for titration or dose adjustments. These novel agents represent a landmark shift in anticoagulant care; however, many aspects of their use will be unfamiliar to practicing clinicians, despite the imminent widespread use of these agents in the community. The management of these anticoagulants when transitioning from or back to warfarin, around surgery or in case of major hemorrhage, requires knowledge of their pharmacokinetics and mechanism of action. Unfortunately, there is a limited evidence base to inform decisions around management of these agents. We present our practice in these settings supported, where available, with literature evidence. (Blood. 2012;119(13): 3016-3023) IntroductionDabigatran has become available for long-term use in the United States and Canada at the end of 2010 and is the first novel antithrombotic agent approved for stroke prophylaxis in atrial fibrillation since the introduction of warfarin more than 50 years ago. 1 The Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) study provided high-quality evidence that, when administered at a dose of 150 mg twice daily, dabigatran is associated with a reduced risk of stroke and a similar risk of bleeding as warfarin when targeted to an international normalized ratio (INR) of 2.0 to 3.0. 2 When administered at a dose of 110 mg twice daily, the risk of stroke with dabigatran is similar to that of warfarin while producing less bleeding. This dose is approved in Canada but not in the United States because it did not reduce the risk of stroke compared with warfarin and stroke prevention was considered more important than the benefit of decreased risk for extracranial major bleeding. The dose of 75 mg twice daily is, however, recommended in the United States for patients with severe renal failure (calculated creatinine clearance 15-30 mL/ min). Dabigatran has also been approved for the prevention of deep vein thrombosis after orthopedic surgery in Canada, Europe, 3 and several other countries, and has been studied in the setting of long-term secondary prevention for venous thromboembolism. 4 Peer organization guidelines now recommend the use of dabigatran for many patients with atrial fibrillation. 5 The oral factor Xa inhibitor, rivaroxaban, has also been approved for prevention of stroke in atrial fibrillation and of venous thrombosis after orthopedic surgery. 6 Clinicians are intimately familiar with warfarin. It has 100% name recognition internationally, monitoring for its anticoagulant effect is routinely available, and physicians are aware of the need to interrupt warfarin for many interventional procedures. 7 There are established and highly effective treatment strategies for bleeding in patients receiving warfarin and for the management of unanticipated excess anticoagulant effe...

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“…8,9 Could a greater disease burden have been responsible for the decreased anticoagulation stability? For example, the prevalence of heart failure, a known contributor to anticoagulation instability, 20 was higher in the patients with CKD (Table 2). However, when we calculated TTR for the subsample of CKD patients with (n = 9) and without heart failure (n = 11), there was no significant difference (mean [SD] heart failure 63% [16%] vs. no heart failure 61% [19%], P = 0.820).…”

Section: ■■ Conclusionmentioning

confidence: 99%

Effect of Chronic Kidney Disease on Warfarin Management in a Pharmacist-Managed Anticoagulation Clinic

Kleinow¹,

Garwood²,

Clemente³

et al. 2011

JMCP

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Outcomes and predictors of very stable INR control during chronic anticoagulation therapy

Abstract: For patients on warfarin therapy, an international normalized ratio (INR) recall interval

Cited by 109 publications

References 21 publications

One-Year Adherence to Warfarin Treatment for Venous Thromboembolism in High-Risk Patients and Its Association with Long-term Risk of Recurrent Events

One-Year Adherence to Warfarin Treatment for Venous Thromboembolism in High-Risk Patients and Its Association with Long-term Risk of Recurrent Events

How I treat with anticoagulants in 2012: new and old anticoagulants, and when and how to switch

Effect of Chronic Kidney Disease on Warfarin Management in a Pharmacist-Managed Anticoagulation Clinic

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