What are the barriers to warfarin use in atrial fibrillation?: Development of a questionnaire

Ingelgård, Anders; Hollowell, Jennifer; Reddy, P. Raveendra; Gold, Karen; Tran, Kimbach T.; Fitzmaurice, David

doi:10.1007/s11239-006-5633-2

Cited by 44 publications

(62 citation statements)

References 22 publications

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“…5 More US patients were aware that medications interact with warfarin (US 72% vs HK 37%), although slightly more Hong Kong patients were aware of the interactions of warfarin with vitamins (US 35% vs HK 44%). 5 …”

Section: Questionnaire For Patientsmentioning

confidence: 99%

“…Regarding warfarin knowledge, more US patients understood what a therapeutic INR was (US 78% vs HK 37%), and that dietary changes can affect warfarin anticoagulation (US 68% vs HK 47%). 5 Fewer US patients did not know the importance of controlling their daily intake of vitamin K during warfarin therapy (US 9% vs HK 66%). 5 More US patients were aware that medications interact with warfarin (US 72% vs HK 37%), although slightly more Hong Kong patients were aware of the interactions of warfarin with vitamins (US 35% vs HK 44%).…”

Section: Questionnaire For Patientsmentioning

confidence: 99%

“…5 Fewer US patients did not know the importance of controlling their daily intake of vitamin K during warfarin therapy (US 9% vs HK 66%). 5 More US patients were aware that medications interact with warfarin (US 72% vs HK 37%), although slightly more Hong Kong patients were aware of the interactions of warfarin with vitamins (US 35% vs HK 44%). 5 …”

Section: Questionnaire For Patientsmentioning

confidence: 99%

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Barriers to Warfarin Use for Stroke Prevention in Patients With Atrial Fibrillation in Hong Kong

Lee

Tam

Yan

et al. 2012

Clinical Cardiology

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Background:Oral anticoagulation medications such as warfarin reduce the risk of stroke in atrial fibrillation (AF) but have been underutilized. This study aimed to investigate physicians' perceptions of stroke prevention management and patients' knowledge of AF and warfarin therapy in Hong Kong (HK).Hypothesis:Both physician and patient's knowledge on warfarin use were the barriers for stroke prevention in patients with atrial fibrillation in Hong Kong.Methods:This prospective survey‐based study was conducted between February 2011 and April 2011 to assess physicians' perceptions of stroke prevention management, patients' knowledge of AF, and patients' knowledge of warfarin therapy. The results were scored and compared with those in foreign countries.Results:Sixty‐two physicians and 114 warfarin users were recruited in the study. The average score of HK physicians in the knowledge of stroke prevention therapy in AF patients was lower than that of Australian (AUS) family physicians (HK 2.48 vs AUS 4.02 out of 7). The mean scores of AF patients in Hong Kong regarding the knowledge of AF were lower than that of United Kingdom (UK) (HK 1.16 vs UK 2.24 out of 4) (P < 0.001) and that of Finland (FIN) (HK 2.77 vs FIN 5.94 out of 8) (P < 0.001), respectively. The mean score of AF patients in Hong Kong regarding the knowledge of warfarin therapy was lower than that of AF patients in the United States (US) (HK 2.39 vs US 3.92).Conclusions:The barriers of warfarin use for AF patients in Hong Kong were related to both physicians and patients. Many Hong Kong physicians did not comply with international recommendations of stroke prevention in AF patients, and AF patients had a low knowledge level about the disease and warfarin therapy.Presented at the International Congress of Cardiology, Hong Kong, Peoples Republic of China, February 24‐26, 2012.This study was supported by the School of Pharmacy, the Chinese University of Hong Kong.The authors have no other funding, financial relationships, or conflicts of interest to disclose.

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Section: Questionnaire For Patientsmentioning

confidence: 99%

Section: Questionnaire For Patientsmentioning

confidence: 99%

Section: Questionnaire For Patientsmentioning

confidence: 99%

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Barriers to Warfarin Use for Stroke Prevention in Patients With Atrial Fibrillation in Hong Kong

Lee

Tam

Yan

et al. 2012

Clinical Cardiology

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“…Although shared decision-making, patients' preferences, and noncompliance with medical regimens are certainly factors in OAC underuse, clinicians' judgment appears to play the chief role. [21][22][23][24] The reasons typically cited for not prescribing OACs are bleeding risk, older age, the risk of falls, and patient noncompliance. [23][24][25] In fact, two of the strongest risk factors for stroke in AF-prior stroke and increasing age-are actually indicators of withholding appropriate anticoagulant therapy.…”

Section: Underuse Of Oral Anticoagulants For Nonvalvular Atrial Fibrimentioning

confidence: 99%

Underuse of Oral Anticoagulants for Nonvalvular Atrial Fibrillation: Past, Present, and Future

Wehbe¹,

Yadlapati²

2016

Texas Heart Institute Journal

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“…3,76 Recent reports estimate hemorrhagic complication rates of 5-7.9% for major (serious, life-threatening, or fatal) hemorrhage and 14-36% for minor (e.g. nose bleeds, microscopic hematuria) hemorrhage.…”

Section: Influence Of Cyp2c9 and Vkorc1 On Anticoagulation Attainmentmentioning

confidence: 99%

Warfarin Pharmacogenetics

García¹

2009

N Engl J Med

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SummaryThere has been significant interest in the pharmacogenetics of warfarin therapy with the recent package insert update highlighting its potential role in improving the safety and effectiveness of warfarin. Herein we review the evidence of the influence of the two key genes of interest, CYP2C9 and VKORC1, on warfarin response, and discuss the implications of current knowledge for clinical practice.The influence of CYP2C9 and VKORC1 genotype on warfarin dose requirements has been consistently demonstrated in diverse racial/ ethnic patient groups in observational studies and randomized clinical trails. Dosing algorithms have been developed that incorporate clinical, demographic, and genetic information to help select a starting warfarin dose. Furthermore, CYP2C9 variant genotypes have been associated with a significantly increased risk of serious bleeding events.However evidence to date from prospective, controlled studies has not demonstrated an added benefit of incorporating genotype-guided therapy in improving anticoagulation control, preventing or reducing the risk of hemorrhagic or thromboembolic complications. Research efforts designed to evaluate the effectiveness of genotype-guided therapy in improving outcomes are underway. However the routine use of CYP2C9 and VKORC1 genotyping in the general patient population initiating warfarin therapy is not supported by evidence currently available.

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What are the barriers to warfarin use in atrial fibrillation?: Development of a questionnaire

Cited by 44 publications

References 22 publications

Barriers to Warfarin Use for Stroke Prevention in Patients With Atrial Fibrillation in Hong Kong

Barriers to Warfarin Use for Stroke Prevention in Patients With Atrial Fibrillation in Hong Kong

Underuse of Oral Anticoagulants for Nonvalvular Atrial Fibrillation: Past, Present, and Future

Warfarin Pharmacogenetics

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