Article

Warfarin pharmacology, clinical management, and evaluation of hemorrhagic risk for the elderly.

Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467, USA.
Cardiology Clinics (impact factor: 1.36). 06/2008; 26(2):157-67, v. DOI:10.1016/j.ccl.2007.12.010 pp.157-67, v
Source: PubMed

ABSTRACT Warfarin, a vitamin K antagonist, is currently the most extensively used oral anticoagulant world-wide. It is prescribed for a variety of indications and has undergone extensive clinical study. Still, despite wide usage and considerable accumulated data from clinical trials demonstrating efficacy for a variety of thrombotic and thromboembolic conditions, warfarin is underutilized because its management is complex for both patients and physicians. However, despite these limitations, warfarin can be managed with relative safety, even in an elderly population.

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    Dataset: A U Adverse drug events associated with vitamin K antagonists: factors of therapeutic imbalance
    N El, Helou Amal, Al-Hajje R Ajrouche, Sanaa Awada, Samar Rachidi, Salam Zein, Pascale Salameh
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    ABSTRACT: Background: Adverse drug events (ADE) occur frequently during treatment with vitamin K
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    Article: Anticoagulation in the Elderly
    Robert-Ebadi Helia, Righini Marc
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    ABSTRACT: Management of anticoagulation in elderly patients represents a particularly challenging issue. Indeed, this patient population is at high thromboembolic risk, but also at high hemorrhagic risk. Assessment of the benefit-risk balance of anticoagulation is the key point when decisions are made about introducing and/or continuing such treatments in the individual elderly patient. In order to maximise the safety of anticoagulation in the elderly, some specific considerations need to be taken into account, including renal insufficiency, modified pharmacodynamics of anticoagulants, especially vitamin K antagonists, and the presence of multiple comorbidities and concomitant medications. New anticoagulants could greatly simplify and possibly increase the safety of anticoagulation in the elderly in the near future.
    Pharmaceuticals. 01/2010;
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    Article: A role for pharmacists in community-based post-discharge warfarin management: protocol for the 'the role of community pharmacy in post hospital management of patients initiated on warfarin' study.
    Leanne Stafford, Gregory M Peterson, Luke R E Bereznicki, Shane L Jackson
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    ABSTRACT: Shorter periods of hospitalisation and increasing warfarin use have placed stress on community-based healthcare services to care for patients taking warfarin after hospital discharge, a high-risk period for these patients. A previous randomised controlled trial demonstrated that a post-discharge service of 4 home visits and point-of-care (POC) International Normalised Ratio (INR) testing by a trained pharmacist improved patients' outcomes. The current study aims to modify this previously trialled service model to implement and then evaluate a sustainable program to enable the smooth transition of patients taking warfarin from the hospital to community setting. The service will be trialled in 8 sites across 3 Australian states using a prospective, controlled cohort study design. Patients discharged from hospital taking warfarin will receive 2 or 3 home visits by a trained 'home medicines review (HMR)-accredited' pharmacist in their 8 to 10 days after hospital discharge. Visits will involve a HMR, comprehensive warfarin education, and POC INR monitoring in collaboration with patients' general practitioners (GPs) and community pharmacists. Patient outcomes will be compared to those in a control, or 'usual care', group. The primary outcome measure will be the proportion of patients experiencing a major bleeding event in the 90 days after discharge. Secondary outcome measures will include combined major bleeding and thromboembolic events, death, cessation of warfarin therapy, INR control at 8 days post-discharge and unplanned hospital readmissions from any cause. Stakeholder satisfaction will be assessed using structured postal questionnaire mailed to patients, GPs, community pharmacists and accredited pharmacists at the completion of their study involvement. This study design incorporates several aspects of prior interventions that have been demonstrated to improve warfarin management, including POC INR testing, warfarin education and home visits by trained pharmacists. It faces several potential challenges, including the tight timeframe for patient follow-up in the post-discharge period. Its strengths lie in a strong multidisciplinary team and the utilisation of existing healthcare frameworks. It is hoped that this study will provide the evidence to support the national roll-out of the program as a new Australian professional community pharmacy service. Australian New Zealand Clinical Trials Registry Number 12608000334303.
    BMC Health Services Research 01/2011; 11:16. · 1.66 Impact Factor

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Keywords

considerable
 
efficacy
 
extensive clinical study
 
extensively
 
oral anticoagulant world-wide
 
physicians
 
relative safety
 
thromboembolic conditions
 
vitamin K antagonist
 
Warfarin
 
wide usage