Standardized warfarin monitoring decreases adverse drug reactions

Shields, Lisa B. E.; Fowler, Paula J.; Siemens, Diane M.; Lorenz, D.; Wilson, Kenneth; Hester, Steven T.; Honaker, Joshua T.

doi:10.1186/s12875-019-1041-5

Cited by 11 publications

(10 citation statements)

References 29 publications

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“…Explaining that their physicians used Warfarin in patients who had well self-management (Alalwan et al, 2017). HAS-BLED is scoring system to assess bleeding risk in patient with atrial fibrillations based on factors such as hypertension, abnormal renal and liver function, stroke, bleeding tendency, labile INR in patients taking warfarin, elderly age and the use of other medications (Shields et al, 2019). HAS-BLED has been found to predict hemorrhage risk better compared with another score (Hart et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies investigating the prevalence of warfarin have been done and the results showed an overall decline in the prescribing rate of warfarin, a study showed that the usage of warfarin in atrial fibrillation decreased from 69.8% in 2008 to 42.2% in 2014 and another showed a significantly decrease from 72.2% to 42.1% over a 5-year period from 2013 to 2017 (Alalwan et al, 2017;Shields et al, 2019). However, in Saudi Arabia the extent to which the DOACs have been used is unknown.…”

Section: Introductionmentioning

confidence: 99%

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The prevalence of using direct oral anticoagulants (DOACs) versus warfarin in atrial fibrillation at King Abdullah Medical City (KAMC) in Makkah, Saudi Arabia

Fodah¹,

Alkhalaf²,

Alzahrani³

et al. 2023

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Introduction: Atrial fibrillation is an irregular and can be a very rapid heart rate disorder. It is a type of arrhythmia that increases the risk of stroke and associated with increasing the risk of heart failure and all-cause mortality. Warfarin has been commonly prescribed in the treatment and prevention of different thromboembolic conditions including the atrial fibrillation. However, in recent years, several new oral anticoagulant medications with a direct and reversible inhibitory effect on the enzymatic activity of thrombin (dabigatran) or factor Xa (apixaban and rivaroxaban) in the coagulation cascade have been developed and approved by the FDA as an equivalent to warfarin or even more effective. We are doing this study to show the prevalence of those three drugs compared to warfarin and to estimate the patient's eligibility for using warfarin compared to the new oral anticoagulants. Method: Retrospective study, at Cardiology department at King Abdullah Medical city (KAMC) in Makkah. Result: We screened a total of 267 patients, out of 144 patients who were taking DOACs, 97 (74.6%) were included. And out of 123 patients who were taking warfarin, 33 (25.4%) of them were included. Patients were excluded because they don't have the right diagnosis, or do not have INR or serum creatinine results. Pregnant and lactating women were also excluded. Conclusion: Since FDA approval, apixaban and dabigatran use in AF has increased dramatically compared to warfarin which was diminished. In patients with AF, risks of stroke/SE and major bleeding were lower with DOACs versus warfarin. However, it is vital to perform continuous monitoring of these medication effectiveness.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The prevalence of using direct oral anticoagulants (DOACs) versus warfarin in atrial fibrillation at King Abdullah Medical City (KAMC) in Makkah, Saudi Arabia

Fodah¹,

Alkhalaf²,

Alzahrani³

et al. 2023

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“…In the present study, at least one pharmacogenomic variant in most patients was identified; however, relevant medication use was infrequent among individuals with an actionable genotype. Because the enrolling physicians used alternative strategies to mitigate adverse drug effects—prescribing simvastatin doses lower than 80 mg to avoid myopathy [ 44 ], warfarin titration based on INR [ 45 ], and concurrent prescription of proton pump inhibitors for patients treated with NSAIDs [ 46 ]––only three patients received genotype-directed medication adjustments. Several patients with variant genotypes were not recommended by the precision medicine team to undergo genotype-directed drug adjustments in the event they were stable on a long-term prescription.…”

Section: Discussionmentioning

confidence: 99%

Real-World Evaluation of a Population Germline Genetic Screening Initiative for Family Medicine Patients

Hutchcraft

Zhang

Lin

et al. 2022

JPM

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Hereditary factors contribute to disease development and drug pharmacokinetics. The risk of hereditary disease development can be attenuated or eliminated by early screening or risk reducing interventions. The purpose of this study was to assess the clinical utility of germline medical exome sequencing in patients recruited from a family medicine clinic and compare the mutation frequency of hereditary predisposition genes to established general population frequencies. At the University of Kentucky, 205 family medicine patients underwent sequencing in a Clinical Laboratory Improvement Amendments of 1988-compliant laboratory to identify clinically actionable genomic findings. The study identified pathogenic or likely pathogenic genetic variants—classified according to the American College of Medical Genetics and Genomics variant classification guidelines—and actionable pharmacogenomic variants, as defined by the Clinical Pharmacogenetics Implementation Consortium. Test results for patients with pharmacogenomic variants and pathogenic or likely pathogenic variants were returned to the participant and enrolling physician. Hereditary disease predisposition gene mutations in APOB, BRCA2, MUTYH, CACNA1S, DSC2, KCNQ1, LDLR, SCN5A, or SDHB were identified in 6.3% (13/205) of the patients. Nine of 13 (69.2%) underwent subsequent clinical interventions. Pharmacogenomic variants were identified in 76.1% (156/205) of patients and included 4.9% (10/205) who were prescribed a medication that had pharmacogenomic implications. Family physicians changed medications for 1.5% (3/205) of patients to prevent toxicity. In this pilot study, we found that with systemic support, germline genetic screening initiatives were feasible and clinically beneficial in a primary care setting.

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“…Oral anticoagulants, including warfarin and novel oral anticoagulants (NOACs), are used to treat venous thromboembolism, such as pulmonary embolism and deep vein thrombosis, and prevent stroke in patients with atrial fibrillation ( Keeling et al, 2011 ; Mueck et al, 2014 ; Cohen et al, 2015 ; Cohen et al, 2016 ; Witt et al, 2016 ; Bai et al, 2017 ). If used improperly, oral anticoagulants can result in thrombosis or bleeding ( Lin et al, 2019 ; Shields et al, 2019 ) and therefore reduce the quality of life ( Lozano Sanchez and Areitio-Aurtena Bolumburu, 2008 ; Sallinen et al, 2019 ). Dissatisfaction with anticoagulation is associated with poor adherence, international normalized ratio (INR) control, and clinical outcomes ( Perino et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

The Transcultural Adaptation and Validation of the Chinese Version of the Duke Anticoagulation Satisfaction Scale

Dong

et al. 2022

Front. Pharmacol.

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Background: The Duke Anticoagulation Satisfaction Scale (DASS) offers a method to measure the quality of life and satisfaction of patients taking oral anticoagulants. The study aimed to validate the Chinese version of the DASS in Chinese patients on anticoagulation therapy.Methods: The DASS was translated, back-translated, and transculturally adapted into the Chinese version and then administered to participants taking oral anticoagulants in a physician–pharmacist collaborative anticoagulation clinic at a tertiary teaching hospital from October 2019 to December 2020. Reliability was analyzed through Cronbach’s alpha (α) and split-half reliability. Confirmatory factor analysis was performed to test the structural validity of the scale. Exploratory factor analysis was performed for items in the scales using the varimax rotation method.Results: A total of 189 patients completed the Chinese version of the DASS. Four dimensions and 23 items were included, with Cronbach’s α values of 0.89, 0.81, 0.89, and 0.74 for limitations on physical activities, diet restrictions, hassles and burdens, and positive psychological effect, respectively. Cronbach’s α coefficient of whole scale was 0.91. The split-half reliability of this scale is 0.747 (>0.7).Conclusion: The Chinese version of the DASS indicated excellent reliability and validity, compared to the original version. It could provide a practical instrument for healthcare practitioners to evaluate satisfaction and quality of life for anticoagulated patients in China. The difference in quality of life between patients taking warfarin and novel oral anticoagulants (NOACs) needs to be further explored in future studies.

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Standardized warfarin monitoring decreases adverse drug reactions

Cited by 11 publications

References 29 publications

The prevalence of using direct oral anticoagulants (DOACs) versus warfarin in atrial fibrillation at King Abdullah Medical City (KAMC) in Makkah, Saudi Arabia

The prevalence of using direct oral anticoagulants (DOACs) versus warfarin in atrial fibrillation at King Abdullah Medical City (KAMC) in Makkah, Saudi Arabia

Real-World Evaluation of a Population Germline Genetic Screening Initiative for Family Medicine Patients

The Transcultural Adaptation and Validation of the Chinese Version of the Duke Anticoagulation Satisfaction Scale

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