Impact of point-of-care international normalized ratio monitoring on quality of treatment with vitamin K antagonists in non-self-monitoring patients: a cohort study

2016 ◽  
Vol 14 (4) ◽  
pp. 695-703 ◽  
Author(s):  
J. S. Biedermann ◽  
N. van Rein ◽  
A. M. H. P. van den Besselaar ◽  
P. N. Buhre ◽  
M. P. M. de Maat ◽  
...  
Keyword(s):  
Cohort Study ◽  
Vitamin K ◽  
Point Of Care ◽  
Vitamin K Antagonists ◽  
International Normalized Ratio ◽  
Self Monitoring ◽  
Quality Of Treatment

The relationship between adherence and quality of treatment with vitamin K antagonists

2004 ◽  
Vol 2 (2) ◽  
pp. 362-363 ◽  
Author(s):  
M. Locadia ◽  
J. H. H. Van Geest-Daalderop ◽  
M. A. G. Sprangers ◽  
B. A. Hutten ◽  
M. H. Prins
Keyword(s):  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Quality Of Treatment ◽  
The Relationship

High Soluble Thrombomodulin Is Associated with an Increased Risk of Major Bleeding during Treatment with Oral Anticoagulants: A Case–Cohort Study

2020 ◽  
Author(s):  
Myrthe M. A. Toorop ◽  
Nienke van Rein ◽  
Suzanne C. Cannegieter ◽  
Felix J. M. van der Meer ◽  
Pieter H. Reitsma ◽  
...  
Keyword(s):  
Cohort Study ◽  
Vitamin K ◽  
Major Bleeding ◽  
Cox Regression ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
International Normalized Ratio ◽  
Soluble Thrombomodulin ◽  
Major Bleed ◽  
Increased Risk

Abstract Background Major bleeding occurs in 1 to 3% of patients treated with oral anticoagulants per year. Biomarkers may help to identify high-risk patients. A proposed marker for major bleeding while using anticoagulants is soluble thrombomodulin (sTM). Methods Plasma was available from 16,570 patients of the BLEEDS cohort that consisted of patients who started treatment with vitamin K antagonists between 2012 and 2014. A case–cohort study was performed including all patients with a major bleed (n = 326) during follow-up and a random sample of individuals selected at baseline (n = 652). Plasma sTM levels were measured and stratified by percentiles. Patients were also categorized by international normalized ratio (INR). Adjusted hazard ratios (for age, sex, hypertension, and diabetes) with 95% confidence intervals (CIs) were estimated by means of Cox regression. Results Plasma sTM levels were available for 263 patients with a major bleed and 538 control subjects. sTM levels were dose-dependently associated with risk of major bleeding, with a 1.9-fold increased risk (95% CI: 1.1–3.1) for levels above the 85th percentile versus the <25th percentile. A high INR (≥4) in the presence of high (≥70th percentile) sTM levels was associated with a 7.1-fold (95% CI: 4.1–12.3) increased risk of major bleeding, corresponding with a bleeding rate of 14.1 per 100 patient-years. Conclusion High sTM levels at the start of treatment are associated with major bleeding during vitamin K antagonist treatment, particularly in the presence of a high INR.

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

Hematology ◽  
2018 ◽  
Vol 2018 (1) ◽  
pp. 332-338
Author(s):  
Vittorio Pengo ◽  
Gentian Denas
Keyword(s):  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Quality Care ◽  
Improve Patient Care ◽  
Educational Process ◽  
Surgical Interventions ◽  
Quality Of Treatment ◽  
Anticoagulation Clinics

Abstract 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.

Vitamin K antagonists

ESC CardioMed ◽  
2018 ◽  
pp. 262-264
Author(s):  
Jørgen Jespersen ◽  
Jane Skov
Keyword(s):  
Vitamin K ◽  
Point Of Care ◽  
Vitamin K Antagonists ◽  
International Normalized Ratio ◽  
World Health ◽  
Computer Assisted ◽  
Clinical Settings ◽  
Self Testing ◽  
Clinical Control ◽  
Health Organization

Vitamin K antagonists are widely used for prevention of thrombosis in patients at high risk. Dosage requirements differ greatly among individuals, and interactions are observed with other pharmaceuticals or dietary compounds, necessitating frequent control of the anticoagulant effect. This can be achieved through monitoring of the international normalized ratio. For providing high-quality treatment with vitamin K antagonists, both laboratory and clinical elements must be optimized. The international normalized ratio is measured in the laboratory or by point-of-care devices, in both cases values according to World Health Organization standardization should be reported and external quality assessment established. Clinical control includes measurements of treatment stability for individual patients and the entire clinic. Novel procedures such as computer-assisted dosage and patient self-testing or self-management can improve clinical quality. The vast existing knowledge of vitamin K antagonists and the ongoing research efforts notwithstanding, treatment of optimal quality is still not achieved in all clinical settings and countries.

A new index to predict quality of anticoagulation control in patients on vitamin K antagonists: the DAFNE score

2020 ◽  
Author(s):  
Vivencio Barrios ◽  
Carlos Escobar ◽  
Luis Prieto ◽  
Jose Polo ◽  
Javier Muñiz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Clinical Score ◽  
International Normalized Ratio ◽  
Concomitant Treatment ◽  
Anticoagulation Control

Aim: To derive a new clinical score to improve the prediction of those at risk of poor International Normalized Ratio control among patients with atrial fibrillation taking vitamin K antagonists. Materials & methods: The score was calculated using PAULA database and validated in the FANTASIIA population. Results: The DAFNE score (cardiovascular Disease, concomitant treatment with Amiodarone, Food/dietary transgression and taking ≥7 pills daily, fEemale sex) score was related to a higher probability of poor International Normalized Ratio control. C-indexes were 0.611 and 0.576 (De Long test, p = 0.007) for the DAFNE and SAMe-TT2R2 scores, respectively. Conclusion: The DAFNE score is a new clinical score which may potentially help determine those patients with atrial fibrillation who are at high risk of poor anticoagulation control with vitamin K antagonists.

Quality of life, adherence and satisfaction of patients with auricular fibrillation treated with dabigatran or vitamin K antagonists

2019 ◽  
Vol 219 (6) ◽  
pp. 285-292
Author(s):  
V. Barrios ◽  
C. Escobar ◽  
G. Barón Esquivias ◽  
J.J. Gómez Doblas ◽  
E. Recalde del Vigo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Vitamin K ◽  
Vitamin K Antagonists
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