Interpretation and management of INR results: A case history based survey in 13 countries
| Autor: | Mathias Müller, Éva Ajzner, Geir Thue, Dianne P. Kitchen, Elisabeth Nilsson, Sverre Sandberg, Rosy Tirimacco, Rina Leonetti, Steve Kitchen, Carmen Perich, Joseph Watine, Piet Meijer, Marge Kutt, Inger Plum, Andrea R. Horvath, Neree Claes, Ann Helen Kristoffersen, Felix J. M. van der Meer, Dunja Rogić, Kaja Kallion |
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| Rok vydání: | 2012 |
| Předmět: |
Response rate (survey)
Pediatrics medicine.medical_specialty Internationality business.industry MEDLINE Case-control study Anticoagulants Thrombosis Atrial fibrillation Orvostudományok Hematology Primary care Klinikai orvostudományok medicine.disease Secondary care Case-Control Studies Atrial Fibrillation Humans Medicine Dose reduction International Normalized Ratio Practice Patterns Physicians' Level of care business |
| Zdroj: | Thrombosis Research. 130:309-315 |
| ISSN: | 0049-3848 |
| DOI: | 10.1016/j.thromres.2012.02.014 |
| Popis: | Introduction Standardisation of treatment with vitamin K antagonists (VKAs) is still an issue after 60 years of use. The study aimed to explore aspects of VKA monitoring in primary and secondary care. Methods Two case histories were distributed to physicians in 13 countries. Case history A focused on a patient with atrial fibrillation on stable anticoagulation (latest INR 2.3). Physicians were asked about frequency of INR measurement, when to change the VKA dose, and the patient's annual risk of ischemic stroke and bleeding. Case history B focused on a patient with an unexpected INR of 4.8, asking for the patient's 48-hour bleeding risk, the immediate dose reduction and time until a repeat INR. Results Altogether, 3016 physicians responded (response rate 8 – 38%), of which 82% were from primary care and 18% from secondary care. Answers varied substantially within and between countries regardless of level of care and VKA used. Median number of weeks between INR measurements was 4 – 6 weeks. Median threshold INR for increasing or decreasing the VKA dose was 1.9 and 3.1, respectively. Risk of ischemic stroke and bleeding were overestimated 2 – 3 times. In case history B, the median dose reduction the two first days was 75% for GPs and 55% for specialists, irrespective of estimates of bleeding risk; with one week to a repeat INR. Conclusion Variation in VKA monitoring is substantial implying clinical consequences. Guidelines seem either unknown or may be considered impracticable. Further efforts towards standardisation of VKA management are needed. |
| Databáze: | OpenAIRE |
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