Elderly Diasabled Patients in Oral Anticoagulation Treatment:An Evaluation of a Bioanalyst-Led Management Program Reaching an Average of 72% of Time in Therapeutic Range
| Autor: | Gitte Vedel Melsen, Thomas Vedtofte, Christina Ellervik, Maja Jørgensen, Lise Bathum |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Domiciliary care
endocrine system medicine.medical_specialty business.industry Point-of-care testing Warfarin Time in therapeutic range Atrial fibrillation medicine.disease INR self-monitoring Emergency medicine Oral vitamin Medicine cardiovascular diseases business Intensive care medicine Oral anticoagulation medicine.drug |
| Zdroj: | Vedtofte, T, Vedel Melsen, G & Bathum, L 2014, ' Elderly Diasabled Patients in Oral Anticoagulation Treatment : An Evaluation of a Bioanalyst-Led Management Program Reaching an Average of 72% of Time in Therapeutic Range ', World Journal of Cardiovascular Diseases, vol. 4, pp. 623-630 . https://doi.org/10.4236/wjcd.2014.412074 |
| DOI: | 10.4236/wjcd.2014.412074 |
| Popis: | Introduction: The need for anticoagulation therapy increases with age, mainly due to the increased prevalence of atrial fibrillation. Time in therapeutic range (TTR) is a marker of the quality of the therapy as TTR is inversely correlated with adverse reactions. We developed a bioanalyst-led management program for control of warfarin treatment in elderly disabled patients in their own home and maintain a high TTR. Material and Methods: Residents in nursing home settings were included. Visiting nurses measured INR with a point of care testing device. If INR was within Therapeutic Range (TR), the nurse dosed warfarin unaltered. If INR was out of TR, the visiting nurse contacted a specially trained bioanalyst by phone. An explanation was sought, and a new dosage plan was made. Results: A total of 579 patients were included; 356 females (61%). Mean age was 79.6 years. Approximately 10% were residents in nursing home settings and the rest in domiciliary care. TTR was 72%. The subtherapeutic values were 15% and supratherapeutic values 13%. In total, 139 patients died during the study period. Ten deaths could be related to possible side effects of warfarin treatment. Conclusions: Our results indicate that a bioanalyst-led program is able to simplify anticoagulation monitoring, while maintaining INR control similar to a specialized clinic. Furthermore, we avoided hospitalizations when INR was unacceptably high by treating the patient with oral vitamin-K at home. Our findings could be helpful when planning warfarin treatment in elderly, fragile patients. |
| Databáze: | OpenAIRE |
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