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BMC Public Health Jul 2021Assessment health literacy in people with cardiovascular health problems would facilitate the development of appropriate health strategies for the care and reduction of...
BACKGROUND
Assessment health literacy in people with cardiovascular health problems would facilitate the development of appropriate health strategies for the care and reduction of complications associated with oral anticoagulation therapy.
AIM
To evaluate the relationship between health literacy and health and treatment outcomes (concordance with oral anticoagulants, Normalized Ratio control and occurrence of complications) in patients with cardiovascular pathology.
METHODS
Observational, analytic and cross-sectional study carried out on 252 patients with cardiovascular pathology (atrial fibrillation, flutter or valve prosthesis), aged 50-85 years, accessing primary care services in Valencia (Spain) in 2018-2019. Variables referring to anticoagulant treatment with vitamin K antagonists (years of treatment, adequate control, polypharmacy and occurrence of complications, among others) and health literacy (Health Literacy Questionnaire) were analysed.
RESULTS
All dimensions of health literacy were significantly related to the level of education (p < 0.02), social class (p < 0.02), an adequate control of acenocoumarol (p < 0.001), frequentation of health services (p < 0.001), information by patients to health professionals about anticoagulant treatment (p < 0.03), emergency care visits (p < 0.001) and unscheduled hospital admissions (p < 0.001).
CONCLUSION
Health literacy has a relevant influence on the adequate self-management of anticoagulation treatment and the frequency of complications. The different dimensions that comprise health literacy play an important role, but the "social health support" dimension seems to be essential for such optimal self-management.
TRIAL REGISTRATION
ACC-ACE-2016-01. Registration date: December 2015.
Topics: Administration, Oral; Anticoagulants; Atrial Fibrillation; Cross-Sectional Studies; Health Literacy; Humans; Social Determinants of Health; Spain; Treatment Outcome
PubMed: 34243749
DOI: 10.1186/s12889-021-11259-w -
Farmacia Hospitalaria : Organo Oficial... May 2021Adverse drug events are a well-known cause of emergency department admissions. FARM-URG is a project promoted by the REDFASTER working group of the Spanish Society...
OBJECTIVE
Adverse drug events are a well-known cause of emergency department admissions. FARM-URG is a project promoted by the REDFASTER working group of the Spanish Society of Hospital Pharmacy. Its aim is to evaluate these adverse events through regular prevalence measurements. The present study shows the results of the first observations. The goal was to determine the prevalence of adverse drug events with respect to the total number of patients treated in emergency departments and carry out a description of the different events identified.
METHOD
This is a multicenter cross-sectional study carried out in the emergency room of 13 Spanish hospitals. The identification and registration of patients were obtained from the emergency department patient census at the time of the first prevalence measurement (16 June 2020). The REDCap® platform was used for patient registration.
RESULTS
The 2020 FARM-URG registry, which included 13 hospitals, evaluated 772 patients, of whom 57 (7.4%) consulted for adverse drug events. Antithrombotic drugs were responsible for most of these episodes, acenocoumarol being the main drug involved (22.8%). Nine (15.8%) adverse drug events were caused by inappropriate drug prescriptions according to the STOPP-START criteria. Nineteen (33.0%) patients returned to the emergency service within 30 days from discharge.
CONCLUSIONS
Adverse drug events are a frequent cause of emergency department visits and are commonly associated with a significant percentage of re-visits. The FARM-URG project has been created with the purpose of obtaining dynamic and updated information on such events.
Topics: Cross-Sectional Studies; Drug-Related Side Effects and Adverse Reactions; Emergency Service, Hospital; Farms; Humans; Prevalence
PubMed: 34218762
DOI: 10.7399/fh.11596 -
Journal of Clinical Medicine Jun 2021Patients with venous thromboembolism (VTE) require immediate treatment with anticoagulants such as acenocoumarol. This multicentre randomised clinical trial evaluated...
Patients with venous thromboembolism (VTE) require immediate treatment with anticoagulants such as acenocoumarol. This multicentre randomised clinical trial evaluated the effectiveness of a dosing pharmacogenetic algorithm versus a standard-of-care dose adjustment at the beginning of acenocoumarol treatment. We included 144 patients with VTE. On the day of recruitment, a blood sample was obtained for genotyping (, , , , ). Dose adjustment was performed on day 3 or 4 after the start of treatment according to the assigned group and the follow-up was at 12 weeks. The principal variable was the percentage of patients with an international normalised ratio (INR) within the therapeutic range on day 7. Thirty-four (47.2%) patients had an INR within the therapeutic range at day 7 after the start of treatment in the genotype-guided group compared with 14 (21.9%) in the control group ( = 0.0023). There were no significant differences in the time to achieve a stable INR, the number of INRs within the range in the first 6 weeks and at the end of study. Our results suggest the use of a pharmacogenetic algorithm for patients with VTE could be useful in achieving target INR control in the first days of treatment.
PubMed: 34209131
DOI: 10.3390/jcm10132949 -
JBJS Case Connector Jun 2021An elderly, polytrauma patient receiving vitamin K antagonist (VKA) for atrial fibrillation required immediate surgery for open distal tibial fracture. As the initial...
CASE
An elderly, polytrauma patient receiving vitamin K antagonist (VKA) for atrial fibrillation required immediate surgery for open distal tibial fracture. As the initial reversal with vitamin K and fresh frozen plasma by the trauma team was ineffective, the "Bleeding Team" was convened and administrated the appropriate four-factor prothrombin complex regimen, reversing the VKA in a timely manner. Surgery was performed under peripheral nerve blockade subsequently. The postoperative course of the patient was uneventful.
CONCLUSION
The individualized approach and the multidisciplinary experts' team guidance is of outmost importance in patients who are treated with anticoagulants and present for nonelective surgery.
Topics: Acenocoumarol; Aged; Anticoagulants; Fractures, Open; Hemorrhage; Humans; Vitamin K
PubMed: 34166270
DOI: 10.2106/JBJS.CC.20.00786 -
PloS One 2021The study examined the Drug-Related Problems (DRPs) of patients with polypharmacy in 78 Hungarian community pharmacies, especially the interaction risks in terms of...
Analysis of interaction risks of patients with polypharmacy and the pharmacist interventions performed to solve them-A multicenter descriptive study according to medication reviews in Hungarian community pharmacies.
OBJECTIVE
The study examined the Drug-Related Problems (DRPs) of patients with polypharmacy in 78 Hungarian community pharmacies, especially the interaction risks in terms of their clinical severity. Also, the objective was to analyze pharmacists' interventions to solve the identified interaction risks.
METHODOLOGY
The research was carried out in the framework of the training of specialist pharmacists at Semmelweis University, with the participation of 78 graduated pharmacists with the collaboration of 98 GPs. A total of 755 patients participated in pharmaceutical counseling which meant a medication review process. DRPs were uniformly categorized and the interventions were recorded by pharmacists, while a detailed analysis of interaction risks was performed by authors.
RESULTS
A total of 984 DRPs were registered. The most common category of DRPs was the "non-quantitative safety problems" (62.6%). Interaction risk was the most common cause of DRPs (54.0%). The highest proportion of interaction risks were between two prescription drugs (66.7%). In 30.7% of interaction risks' cases, there was not known negative outcome. In contrast, it was recommended to modify the therapy in 14.9% of interaction risks. Acetylsalicylic acid (22.8%), acenocoumarol (17.7%), and diclofenac (13.9%) were the most common active substances which caused serious interaction risks. A total of 599 pharmacist interventions were used to solve the 531 interaction risks. Pharmacists notified the GPs about the problem in 28.4% of cases and they intervened without the GP in 63.1% of cases, most often with patient education (27.4%).
CONCLUSION
Medication review by community pharmacists is required for the safe medicine using of patients with polypharmacy, as a significant number of DRPs have been recorded. The incidence of interaction risks stood out. It is essential to develop a pharmaceutical guideline to properly classify the clinical relevance of interaction risks (e.g. according to high-risk active substances) and to increase the collaboration with GPs.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Community Pharmacy Services; Female; Humans; Hungary; Male; Middle Aged; Pharmacists; Polypharmacy; Practice Patterns, Pharmacists'; Risk Factors; Young Adult
PubMed: 34157039
DOI: 10.1371/journal.pone.0253645 -
Annals of Medicine and Surgery (2012) Jun 2021Paradoxical embolism is a rare medical phenomenon. Depending on the site of embolisation, it can cause different symptoms. Although rare, mesenteric ischemia can reveal...
INTRODUCTION
Paradoxical embolism is a rare medical phenomenon. Depending on the site of embolisation, it can cause different symptoms. Although rare, mesenteric ischemia can reveal paradoxical embolism, and the embolisation of two different sites is rarely described in the literature.
CASE PRESENTATION
We report the observation of a patient with a table associating an acute mesenteric ischemia and an acute ischemia of the upper limb; whose the etiological assessment revealed a deep venous thrombosis of the lower limbs complicated by pulmonary embolism.
CLINICAL DISCUSSION
These paradoxical embolisms occurred through a patent foramen ovale. The diagnosis of the patent foramen ovale in this patient was revealed by transthoracic echocardiography, with bubble test. The patient benefited from an embolectomy of the superior mesenteric artery and an embolectomy using fogarty catheter by approching humeral artery at the elbow crease with good postoperative evolution. The patient was put on long-term anticoagulation with Acenocoumarol (because of low socio-economic level of our patient). We didn't recommended the closure of the PFO because of the small size of the shunt and especially because the patient refuses that procedure.
CONCLUSION
Paradoxical embolism remains a pathology rarely mentioned by clinicians, although it can engage the functional and vital prognosis of the patient, hence the interest of a good cardiac evaluation in any patient with embolic ischemia.
PubMed: 34141413
DOI: 10.1016/j.amsu.2021.102426 -
Journal of Clinical Neuroscience :... Jul 2021Effective anticoagulation status may determine the recanalization and outcome of cerebral venous thrombosis (CVT). We report impact of anticoagulation status on...
Effective anticoagulation status may determine the recanalization and outcome of cerebral venous thrombosis (CVT). We report impact of anticoagulation status on recanalization and outcome of CVT. This is a retrospective study on 126 patients with CVT diagnosed on magnetic resonance venography (MRV). Their clinical features and risk factors were noted. The data were retrieved from a prospectively maintained registry, and international normalized ratio (INR) was noted after discharge till 3 months. All the patients were on acenocoumarol. Based on INR value, patients were categorized as Group A (effective anticoagulation INR within the therapeutic range or above) and Group B (ineffective anticoagulation INR > 50% below the therapeutic range). A repeat MRV at 3 months was done for recanalization. Outcome at 3 months was evaluated using modified Rankin Scale (mRS), and categorized as good (mRS ≤ 2) and poor (mRS 2 or more) 101(80.2%) patients were in group A and 25(19.8%) in group B. Their demographic, risk factors, magnetic resonance imaging (MRI) and MRV findings were comparable. On repeat MRV, recanalization occurred in 22/24(91.7%); 15(88%) in group A and 7(100%) in group B. Recanalization was independent of coagulation status. Seven (5.6%) patients died and 107(84.9%) had good outcome; 85(84.2%) in group A and 22(88%) in group B. Kaplan Meier analysis also did not reveal survival or good outcome benefits between the groups. In CVT, outcome and recanalization at 3 months are not dependent on coagulation status. Further prospective studies are needed regarding duration of anticoagulant and its impact on recanalization and outcome.
Topics: Adolescent; Adult; Aged; Anticoagulants; Cerebral Revascularization; Child; Child, Preschool; Female; Humans; International Normalized Ratio; Intracranial Thrombosis; Magnetic Resonance Imaging; Male; Middle Aged; Phlebography; Prospective Studies; Retrospective Studies; Risk Factors; Treatment Outcome; Venous Thrombosis; Young Adult
PubMed: 34119293
DOI: 10.1016/j.jocn.2021.04.016 -
International Journal of Environmental... May 2021The use of vitamin K antagonists (VKAs) in non-valvular atrial fibrillation (NVAF) is complicated due to the narrow therapeutic margin they present and their...
The use of vitamin K antagonists (VKAs) in non-valvular atrial fibrillation (NVAF) is complicated due to the narrow therapeutic margin they present and their unpredictable dose-response relationship. Most studies are based on warfarin, with the results being extrapolated to acenocoumarol. However, studies comparing the two treatments in terms of the degree of anticoagulation control are scarce, justifying the present study. Main factors associated with poor control of time in therapeutic range (TTR) of anticoagulated patients are also studied. Cross-sectional study, with real-world data from patients treated in primary care (PC). Data were obtained from the System for the Improvement of Research in PC (SIDIAP) database, covering 60,978 NVAF-anticoagulated patients from 287 PC centres in 2018. Descriptive statistics were derived, and odds ratios were estimated by multivariate logistic regression. 41,430 patients were considered: 93% were being treated with acenocoumarol and 7% with warfarin. There was no difference in poor control of TTR between the two types of VKA treatment, acenocoumarol and warfarin (38.9 vs. 38.4; = 0.610). Poor anticoagulation control was mainly associated with advanced alcoholism (OR = 1.38), liver failure (OR = 1.37) and intracranial haemorrhage (OR = 1.35) as well as female sex, age < 60 years, cardiovascular history, diabetes mellitus and other variables. There is no association between poor anticoagulation control and the type of VKA treatment administered. Factors associated with poor control of TTR must be considered in clinical practice to improve control and decision-making.
Topics: Acenocoumarol; Anticoagulants; Atrial Fibrillation; Cross-Sectional Studies; Female; Humans; Middle Aged; Primary Health Care; Stroke; Warfarin
PubMed: 34073370
DOI: 10.3390/ijerph18115700 -
American Journal of Health-system... Nov 2021To identify randomized controlled trials that compared antiplatelet monotherapy to combination antiplatelet plus anticoagulant therapy and evaluated major adverse...
PURPOSE
To identify randomized controlled trials that compared antiplatelet monotherapy to combination antiplatelet plus anticoagulant therapy and evaluated major adverse cardiovascular events (MACE) or major adverse limb events (MALE), death, or bleeding in patients with lower extremity peripheral artery disease (PAD).
SUMMARY
A systematic search of MEDLINE, Embase, and CENTRAL databases revealed 5 trials. Two trials consisted of patients with stable PAD, while 3 trials examined patients with PAD post revascularization. Antiplatelet therapy was mostly aspirin (81-325 mg daily), and anticoagulation included rivaroxaban 2.5 mg twice daily or warfarin. Duration of follow-up ranged from 12 to 38 months. Two trials had low risk of bias, whereas 3 trials had high/unclear risk of bias. For patients with stable PAD, one trial showed that use of warfarin (or acenocoumarol) with antiplatelet therapy did not reduce MACE, MALE, or cardiovascular or all-cause death but increased the risk of life-threatening bleeding. A second trial demonstrated that low-dose rivaroxaban plus antiplatelet therapy lowered the risk of MACE and MALE, with no effect in preventing cardiovascular or all-cause death, but increased the risk of major bleeding. For patients with PAD post revascularization receiving warfarin and antiplatelet therapy, 2 trials showed no benefit in MACE or MALE but increased or similar rates of all-cause death and major bleeding. In a third trial, low-dose rivaroxaban plus aspirin reduced occurrence of the composite of MACE and MALE but increased major bleeding, with no effect on cardiovascular or all-cause death.
CONCLUSION
Dual-pathway inhibition with low-dose rivaroxaban and aspirin reduced MACE and MALE in patients with stable or revascularized PAD, but net clinical benefit is questionable.
Topics: Anticoagulants; Drug Therapy, Combination; Factor Xa Inhibitors; Humans; Lower Extremity; Peripheral Arterial Disease; Platelet Aggregation Inhibitors; Rivaroxaban
PubMed: 34059879
DOI: 10.1093/ajhp/zxab226 -
The International Journal of Pharmacy... Aug 2021The objective of this study was to assess the level of Vitamin K antagonist (VKA) therapy knowledge among VKA newly treated patients.
Evaluation of anticoagulant therapy management in a teaching hospital in Tunisia: information and education for vitamin k antagonist newly treated patients need to be improved.
OBJECTIVE
The objective of this study was to assess the level of Vitamin K antagonist (VKA) therapy knowledge among VKA newly treated patients.
METHODS
Questionnaire-based interviews were administered in a university hospital to VKA newly treated patients covering both cognitive (i.e. indication, route of administration, treatment monitoring and side effects) and know-how (i.e. safety precautions, what affects anticoagulant therapy and the management of overdose signs) aspects of therapy knowledge.
KEY FINDINGS
A total of 55 patients were included. The mean overall score of patients' knowledge was 5.78 (SD = 3.425) out of 20. The mean scores of cognitive and practical knowledge were 3.8 (2.26) and 1.98 (1.78) out of 10, respectively. Factors associated with an insufficient level of VKA therapy knowledge included low level of education, lack of access to therapy information and continuous access to this information.
CONCLUSIONS
Knowledge about VKA therapy among newly treated patients is insufficient. Patient's medication knowledge should be improved to ensure better adherence.
Topics: Administration, Oral; Anticoagulants; Educational Status; Hospitals, Teaching; Humans; Tunisia; Vitamin K
PubMed: 34014322
DOI: 10.1093/ijpp/riab024