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Ludovic Drouet - One of the best experts on this subject based on the ideXlab platform.
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Descriptive analysis of the process and quality of oral Anticoagulation management in real-life practice in patients with chronic non-valvular atrial fibrillation: the international study of Anticoagulation management (ISAM)
Journal of Thrombosis and Thrombolysis, 2007Co-Authors: Jack Ansell, Vittorio Pengo, Jennifer Hollowell, Fernando Martinez-brotons, Jaime Caro, Ludovic DrouetAbstract:Background/objectives Expert oral Anticoagulation management is the key to good outcomes and is performed variably in different health care systems throughout the world. We set out to assess the quality of Anticoagulation management in five countries in patients receiving vitamin K antagonists (VKAs) for stroke prophylaxis in chronic non-valvular atrial fibrillation (NVAF), and to compare the Anticoagulation management practices in these countries. Methods and results This was a retrospective, multi-centre cohort study in the United States, Canada, France, Italy, and Spain. About 1,511 patients were randomly recruited from representative practices (routine medical care (RMC) in the US, Canada, and France; Anticoagulation clinics in Italy and Spain) and data pertaining to their oral Anticoagulation care were abstracted from their medical records. The predominant anticoagulant in use was warfarin in the US, Canada, and Italy; acenocoumarol in Spain; and fluindione in France. Documentation of care was poor in the US, Canada, and France, countries where RMC was studied. Percent INRs or time-in-therapeutic range was greater in the two Anticoagulation clinic samples compared with the RMC samples. Conclusion Oral Anticoagulation care varies considerably from country to country. Findings suggest that Anticoagulation clinic care (ACC) may provide better outcomes as assessed by international normalized ratio (INR) time-in-range. Physicians tend to under treat more than over treat. Finally, documentation of care is often inadequate. Condensed Abstract Oral Anticoagulation management (routine medical care or Anticoagulation clinic care) was retrospectively assessed in 5 countries using a uniform, structured assessment tool. Major management differences were detected, especially between Anticoagulation clinic care and routine care. Documentation was often a problem in the latter setting. Less time in therapeutic INR range was noted in routine medical care. Findings suggest that Anticoagulation clinic care may provide better outcomes as assessed by international normalized ratio (INR) time-in-range. Physicians tend to under treat more than over treat. Finally, documentation of care is often inadequate.
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descriptive analysis of the process and quality of oral Anticoagulation management in real life practice in patients with chronic non valvular atrial fibrillation the international study of Anticoagulation management isam
Journal of Thrombosis and Thrombolysis, 2007Co-Authors: Jack Ansell, Vittorio Pengo, Jennifer Hollowell, Fernando Martinezbrotons, Jaime J Caro, Ludovic DrouetAbstract:Background/objectives Expert oral Anticoagulation management is the key to good outcomes and is performed variably in different health care systems throughout the world. We set out to assess the quality of Anticoagulation management in five countries in patients receiving vitamin K antagonists (VKAs) for stroke prophylaxis in chronic non-valvular atrial fibrillation (NVAF), and to compare the Anticoagulation management practices in these countries.
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descriptive analysis of the process and quality of oral Anticoagulation management in real life practice in patients with chronic non valvular atrial fibrillation the international study of Anticoagulation management isam
Journal of Thrombosis and Thrombolysis, 2007Co-Authors: Jack Ansell, Vittorio Pengo, Jennifer Hollowell, Fernando Martinezbrotons, Jaime J Caro, Ludovic DrouetAbstract:Background/objectives Expert oral Anticoagulation management is the key to good outcomes and is performed variably in different health care systems throughout the world. We set out to assess the quality of Anticoagulation management in five countries in patients receiving vitamin K antagonists (VKAs) for stroke prophylaxis in chronic non-valvular atrial fibrillation (NVAF), and to compare the Anticoagulation management practices in these countries.
Richard P Whitlock - One of the best experts on this subject based on the ideXlab platform.
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how did we get here a historical review and critical analysis of Anticoagulation therapy following mechanical valve replacement
Circulation, 2019Co-Authors: Sarah Macisaac, Iqbal H Jaffer, Emilie P Belleycote, Graham R Mcclure, John W Eikelboom, Richard P WhitlockAbstract:Managing severe valvular heart disease with mechanical valve replacement necessitates lifelong Anticoagulation with a vitamin K antagonist. Optimal Anticoagulation intensity for patients with mecha...
Jack Ansell - One of the best experts on this subject based on the ideXlab platform.
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Descriptive analysis of the process and quality of oral Anticoagulation management in real-life practice in patients with chronic non-valvular atrial fibrillation: the international study of Anticoagulation management (ISAM)
Journal of Thrombosis and Thrombolysis, 2007Co-Authors: Jack Ansell, Vittorio Pengo, Jennifer Hollowell, Fernando Martinez-brotons, Jaime Caro, Ludovic DrouetAbstract:Background/objectives Expert oral Anticoagulation management is the key to good outcomes and is performed variably in different health care systems throughout the world. We set out to assess the quality of Anticoagulation management in five countries in patients receiving vitamin K antagonists (VKAs) for stroke prophylaxis in chronic non-valvular atrial fibrillation (NVAF), and to compare the Anticoagulation management practices in these countries. Methods and results This was a retrospective, multi-centre cohort study in the United States, Canada, France, Italy, and Spain. About 1,511 patients were randomly recruited from representative practices (routine medical care (RMC) in the US, Canada, and France; Anticoagulation clinics in Italy and Spain) and data pertaining to their oral Anticoagulation care were abstracted from their medical records. The predominant anticoagulant in use was warfarin in the US, Canada, and Italy; acenocoumarol in Spain; and fluindione in France. Documentation of care was poor in the US, Canada, and France, countries where RMC was studied. Percent INRs or time-in-therapeutic range was greater in the two Anticoagulation clinic samples compared with the RMC samples. Conclusion Oral Anticoagulation care varies considerably from country to country. Findings suggest that Anticoagulation clinic care (ACC) may provide better outcomes as assessed by international normalized ratio (INR) time-in-range. Physicians tend to under treat more than over treat. Finally, documentation of care is often inadequate. Condensed Abstract Oral Anticoagulation management (routine medical care or Anticoagulation clinic care) was retrospectively assessed in 5 countries using a uniform, structured assessment tool. Major management differences were detected, especially between Anticoagulation clinic care and routine care. Documentation was often a problem in the latter setting. Less time in therapeutic INR range was noted in routine medical care. Findings suggest that Anticoagulation clinic care may provide better outcomes as assessed by international normalized ratio (INR) time-in-range. Physicians tend to under treat more than over treat. Finally, documentation of care is often inadequate.
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descriptive analysis of the process and quality of oral Anticoagulation management in real life practice in patients with chronic non valvular atrial fibrillation the international study of Anticoagulation management isam
Journal of Thrombosis and Thrombolysis, 2007Co-Authors: Jack Ansell, Vittorio Pengo, Jennifer Hollowell, Fernando Martinezbrotons, Jaime J Caro, Ludovic DrouetAbstract:Background/objectives Expert oral Anticoagulation management is the key to good outcomes and is performed variably in different health care systems throughout the world. We set out to assess the quality of Anticoagulation management in five countries in patients receiving vitamin K antagonists (VKAs) for stroke prophylaxis in chronic non-valvular atrial fibrillation (NVAF), and to compare the Anticoagulation management practices in these countries.
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descriptive analysis of the process and quality of oral Anticoagulation management in real life practice in patients with chronic non valvular atrial fibrillation the international study of Anticoagulation management isam
Journal of Thrombosis and Thrombolysis, 2007Co-Authors: Jack Ansell, Vittorio Pengo, Jennifer Hollowell, Fernando Martinezbrotons, Jaime J Caro, Ludovic DrouetAbstract:Background/objectives Expert oral Anticoagulation management is the key to good outcomes and is performed variably in different health care systems throughout the world. We set out to assess the quality of Anticoagulation management in five countries in patients receiving vitamin K antagonists (VKAs) for stroke prophylaxis in chronic non-valvular atrial fibrillation (NVAF), and to compare the Anticoagulation management practices in these countries.
Vittorio Pengo - One of the best experts on this subject based on the ideXlab platform.
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d dimer to guide the duration of Anticoagulation in patients with venous thromboembolism a management study
Blood, 2014Co-Authors: Gualtiero Palareti, Sophie Testa, Cristina Legnani, Benilde Cosmi, Angelo Ghirarduzzi, Alberto Tosetto, Emilia Antonucci, Valeria De Micheli, Daniela Poli, Vittorio PengoAbstract:The optimal duration of Anticoagulation in patients with venous thromboembolism (VTE) is uncertain. We investigated whether persistently negative D-dimers in patients with vein recanalization or stable thrombotic burden can identify subjects at low recurrence risk. Outpatients with a first VTE (unprovoked or associated with weak risk factors) were eligible after at least 3 months (12 in those with residual thrombosis) of Anticoagulation. They received serial D-dimer measurements using commercial assays with predefined age/sex-specific cutoffs and were followed for up to 2 years. Of 1010 patients, Anticoagulation was stopped in 528 (52.3%) with persistently negative D-dimer who subsequently experienced 25 recurrences (3.0% pt-y; 95% confidence interval [CI], 2.0-4.4%). Of the remaining 482 patients, 373 resumed Anticoagulation and 109 refused it. Recurrent VTE developed in 15 patients (8.8% pt-y; 95% CI, 5.0-14.1) of the latter group and in 4 of the former (0.7% pt-y; 95% CI, 0.2-1.7; hazard ratio = 2.92; 95% CI, 1.87-9.72; P = .0006). Major bleeding occurred in 14 patients (2.3% pt-y; 95% CI, 1.3-3.9) who resumed Anticoagulation. Serial D-dimer measurement is suitable in clinical practice for the identification of VTE patients in whom Anticoagulation can be safely discontinued. This study was registered at clinicaltrials.gov as #NCT00954395.
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Descriptive analysis of the process and quality of oral Anticoagulation management in real-life practice in patients with chronic non-valvular atrial fibrillation: the international study of Anticoagulation management (ISAM)
Journal of Thrombosis and Thrombolysis, 2007Co-Authors: Jack Ansell, Vittorio Pengo, Jennifer Hollowell, Fernando Martinez-brotons, Jaime Caro, Ludovic DrouetAbstract:Background/objectives Expert oral Anticoagulation management is the key to good outcomes and is performed variably in different health care systems throughout the world. We set out to assess the quality of Anticoagulation management in five countries in patients receiving vitamin K antagonists (VKAs) for stroke prophylaxis in chronic non-valvular atrial fibrillation (NVAF), and to compare the Anticoagulation management practices in these countries. Methods and results This was a retrospective, multi-centre cohort study in the United States, Canada, France, Italy, and Spain. About 1,511 patients were randomly recruited from representative practices (routine medical care (RMC) in the US, Canada, and France; Anticoagulation clinics in Italy and Spain) and data pertaining to their oral Anticoagulation care were abstracted from their medical records. The predominant anticoagulant in use was warfarin in the US, Canada, and Italy; acenocoumarol in Spain; and fluindione in France. Documentation of care was poor in the US, Canada, and France, countries where RMC was studied. Percent INRs or time-in-therapeutic range was greater in the two Anticoagulation clinic samples compared with the RMC samples. Conclusion Oral Anticoagulation care varies considerably from country to country. Findings suggest that Anticoagulation clinic care (ACC) may provide better outcomes as assessed by international normalized ratio (INR) time-in-range. Physicians tend to under treat more than over treat. Finally, documentation of care is often inadequate. Condensed Abstract Oral Anticoagulation management (routine medical care or Anticoagulation clinic care) was retrospectively assessed in 5 countries using a uniform, structured assessment tool. Major management differences were detected, especially between Anticoagulation clinic care and routine care. Documentation was often a problem in the latter setting. Less time in therapeutic INR range was noted in routine medical care. Findings suggest that Anticoagulation clinic care may provide better outcomes as assessed by international normalized ratio (INR) time-in-range. Physicians tend to under treat more than over treat. Finally, documentation of care is often inadequate.
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descriptive analysis of the process and quality of oral Anticoagulation management in real life practice in patients with chronic non valvular atrial fibrillation the international study of Anticoagulation management isam
Journal of Thrombosis and Thrombolysis, 2007Co-Authors: Jack Ansell, Vittorio Pengo, Jennifer Hollowell, Fernando Martinezbrotons, Jaime J Caro, Ludovic DrouetAbstract:Background/objectives Expert oral Anticoagulation management is the key to good outcomes and is performed variably in different health care systems throughout the world. We set out to assess the quality of Anticoagulation management in five countries in patients receiving vitamin K antagonists (VKAs) for stroke prophylaxis in chronic non-valvular atrial fibrillation (NVAF), and to compare the Anticoagulation management practices in these countries.
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descriptive analysis of the process and quality of oral Anticoagulation management in real life practice in patients with chronic non valvular atrial fibrillation the international study of Anticoagulation management isam
Journal of Thrombosis and Thrombolysis, 2007Co-Authors: Jack Ansell, Vittorio Pengo, Jennifer Hollowell, Fernando Martinezbrotons, Jaime J Caro, Ludovic DrouetAbstract:Background/objectives Expert oral Anticoagulation management is the key to good outcomes and is performed variably in different health care systems throughout the world. We set out to assess the quality of Anticoagulation management in five countries in patients receiving vitamin K antagonists (VKAs) for stroke prophylaxis in chronic non-valvular atrial fibrillation (NVAF), and to compare the Anticoagulation management practices in these countries.
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d dimer testing to determine the duration of Anticoagulation therapy
The New England Journal of Medicine, 2006Co-Authors: Gualtiero Palareti, Carlotta Brusi, Corrado Pattacini, Cristina Legnani, Benilde Cosmi, Angelo Ghirarduzzi, Alberto Tosetto, Alfonso Iorio, Vittorio Pengo, Sophie TestaAbstract:Background The optimal duration of oral Anticoagulation in patients with idiopathic venous thromboembolism is uncertain. Testing of d-dimer levels may play a role in the assessment of the need for prolonged Anticoagulation. Methods We performed d-dimer testing 1 month after the discontinuation of Anticoagulation in patients with a first unprovoked proximal deep-vein thrombosis or pulmonary embolism who had received a vitamin K antagonist for at least 3 months. Patients with a normal d-dimer level did not resume Anticoagulation, whereas those with an abnormal d-dimer level were randomly assigned either to resume or to discontinue treatment. The study outcome was the composite of recurrent venous thromboembolism and major bleeding during an average follow-up of 1.4 years. Results The d-dimer assay was abnormal in 223 of 608 patients (36.7%). A total of 18 events occurred among the 120 patients who stopped Anticoagulation (15.0%), as compared with 3 events among the 103 patients who resumed Anticoagulation (2.9%), for an adjusted hazard ratio of 4.26 (95% confidence interval [CI], 1.23 to 14.6; P = 0.02). Thromboembolism recurred in 24 of 385 patients with a normal d-dimer level (6.2%). Among patients who stopped Anticoagulation, the adjusted hazard ratio for recurrent thromboembolism among those with an abnormal d-dimer level, as compared with those with a normal d-dimer level, was 2.27 (95% CI, 1.15 to 4.46; P = 0.02). Conclusions Patients with an abnormal d-dimer level 1 month after the discontinuation of Anticoagulation have a significant incidence of recurrent venous thromboembolism, which is reduced by the resumption of Anticoagulation. The optimal course of Anticoagulation in patients with a normal d-dimer level has not been clearly established. (ClinicalTrials.gov number, NCT00264277.)
Clive Kearon - One of the best experts on this subject based on the ideXlab platform.
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physician preferences for perioperative Anticoagulation in patients with a mechanical heart valve who are undergoing elective noncardiac surgery
Chest, 1999Co-Authors: James D Douketis, Mark Crowther, Sunjay S Cherian, Clive KearonAbstract:Study objective: To determine physicians’ Anticoagulation preferences in patients with a mechanical heart valve who are undergoing elective surgery, and to determine the effect of different risks of thromboembolism (TE) and postoperative bleeding on Anticoagulation preferences. Design: Mail survey of physicians who prescribe anticoagulant therapy. Methods and results: Physicians were asked to provide Anticoagulation preferences in four clinical scenarios of patients with a mechanical heart valve who are undergoing elective surgery. Physicians were asked to select from three preoperative Anticoagulation options (two aggressive, one less aggressive) and four postoperative Anticoagulation options (two aggressive, two less aggressive). IV heparin was the most frequently selected Anticoagulation option. Depending on the scenario, it was preferred by 39 to 79% of respondents for preoperative Anticoagulation therapy, and by 44 to 84% of respondents for postoperative anticoagulant therapy. The risk of TE had a strong influence on Anticoagulation preferences: more respondents preferred aggressive anticoagulant management in high-risk compared with low-risk TE scenarios (p 0.05). Of respondents who preferred IV heparin for postoperative Anticoagulation therapy, the risk of bleeding influenced the timing of heparin initiation: fewer respondents preferred early heparin initiation (within 12 h after surgery) in high-risk compared with low-risk bleeding scenarios (p < 0.01). Conclusions: (1) Preoperative and postoperative IV heparin were the most frequently selected Anticoagulation options. (2) The risk of TE, but not the risk of bleeding, influenced the aggressiveness of anticoagulant management. (3) If IV heparin was selected, the risk of bleeding influenced the timing of heparin initiation. (CHEST 1999; 116:1240 ‐1246)
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physician preferences for perioperative Anticoagulation in patients with a mechanical heart valve who are undergoing elective noncardiac surgery
Chest, 1999Co-Authors: James D Douketis, Mark Crowther, Sunjay S Cherian, Clive KearonAbstract:Study objective To determine physicians' Anticoagulation preferences in patients with a mechanical heart valve who are undergoing elective surgery, and to determine the effect of different risks of thromboembolism (TE) and postoperative bleeding on Anticoagulation preferences. Design Mail survey of physicians who prescribe anticoagulant therapy. Methods and results Physicians were asked to provide Anticoagulation preferences in four clinical scenarios of patients with a mechanical heart valve who are undergoing elective surgery. Physicians were asked to select from three preoperative Anticoagulation options (two aggressive, one less aggressive) and four postoperative Anticoagulation options (two aggressive, two less aggressive). IV heparin was the most frequently selected Anticoagulation option. Depending on the scenario, it was preferred by 39 to 79% of respondents for preoperative Anticoagulation therapy, and by 44 to 84% of respondents for postoperative anticoagulant therapy. The risk of TE had a strong influence on Anticoagulation preferences: more respondents preferred aggressive anticoagulant management in high-risk compared with low-risk TE scenarios (p 0.05). Of respondents who preferred IV heparin for postoperative Anticoagulation therapy, the risk of bleeding influenced the timing of heparin initiation: fewer respondents preferred early heparin initiation (within 12 h after surgery) in high-risk compared with low-risk bleeding scenarios (p Conclusions (1) Preoperative and postoperative IV heparin were the most frequently selected Anticoagulation options. (2) The risk of TE, but not the risk of bleeding, influenced the aggressiveness of anticoagulant management. (3) If IV heparin was selected, the risk of bleeding influenced the timing of heparin initiation.