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gestion d'accueil de l'anticoagulation

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Journal European heart journal supplements
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Liens http://cat.inist.fr/ Google Scholar

Cet article est inclus dans 1 Systematic review Systematic reviews (1 reference)

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RÉSUMÉ: La présente étude porte sur les résultats actuels en matière de gestion de la maison de l'anticoagulation. La littérature indique que, après une formation structurée, les patients motivés ayant des compétences manuelles suffisantes et de la vue sont en mesure de gérer leur propre long terme, un traitement anticoagulant oral. Un niveau stable de l'anti-coagulation peut être atteint par des contrôles hebdomadaires à l'aide, un moniteur de coagulation convivial très précis, réduisant ainsi considérablement le taux de complication en comparaison avec des bilans classiques par le médecin généraliste ou un spécialiste, autogestion des patients non seulement d'économiser les coûts, mais il augmente aussi la qualité de vie des patients.

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Anticoagulation early after mechanical valve replacement: improved management with patient self-testing.

Journal The Journal of thoracic and cardiovascular surgery
Year 2013
Liens Pubmed DOI

Cet article est inclus dans 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: Self-testing to determine the international normalized ratio improves management with warfarin and reduces the risks of adverse events. Self-testing usually begins several weeks after hospital dismissal after valve replacement. We aimed to compare the in-hospital initiation of international normalized ratio self-testing with usual care in mechanical heart valve recipients. METHODS: A total of 200 adult mechanical heart valve recipients were randomly assigned to in-hospital international normalized ratio self-testing instruction or usual care. Instruction for self-testing patients began on the fourth postoperative day. The patients were followed up for 3 months to compare the number of international normalized ratio tests, percentage of time in the therapeutic range, and adverse events. RESULTS: The baseline characteristics were similar between the 2 groups. During the first 3 postoperative months, the usual-care group underwent an average of 10 international normalized ratio tests, and the self-testing group completed 14 international normalized ratio tests. The mean ± SD percentage of international normalized ratio tests within the therapeutic range was 45% ± 22% for the usual-care group and 52% ± 22% for the self-testing group (P = .05). Within 90 days after dismissal, transient ischemic attack occurred in 1 patient in the usual-care group and 2 patients in the self-testing group. Bleeding complications occurred in 3 patients in the usual-care group and 5 patients in the self-testing group. CONCLUSIONS: Management of anticoagulation with warfarin after mechanical valve replacement is improved with self-testing, even during the early postoperative phase when international normalized ratio testing is performed frequently. Although the incidence of adverse events was similar in the 2 groups, better control of the international normalized ratio would be expected to improve outcome in large populations of patients.

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Is home warfarin self-management effective? Results of the randomised Self-Management of Anticoagulation Research Trial.

Journal International journal of cardiology
Year 2013
Liens Pubmed DOI

Cet article est inclus dans 1 Systematic review Systematic reviews (1 reference)

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AIMS: The Warfarin Self-Management Anticoagulation Research Trial (Warfarin SMART) was designed to determine whether patients self-managing warfarin (PSM) using the CoaguChek device and a dosing algorithm developed for the trial could keep the INR (International Normalised Ratio) test in target range at least as often as patients managed by usual care by the family doctor or hospital clinic. METHODS AND RESULTS: 310 patients were randomly assigned to PSM or usual care. The PSM group was trained to perform home INR testing and warfarin dosing using a validated ColourChart algorithm. The primary endpoint was the proportion of times over 12 months that a monthly, blinded "outcome INR test", measured in a central laboratory, was outside the patient's target therapeutic range. The rate of out-of-range outcome INRs was lower in PSM, and non-inferior to the usual care group (PSM: 36% vs. usual care: 41%, P<0.001 for non-inferiority; P=0.08 for superiority in closed-loop testing). The deviations from the patient's midpoint of target INR range (P=0.02) and number of extreme INRs (P=0.03) were significantly less in the PSM group than the usual-care group. There was no significant difference between groups in rates of bleeding or thrombotic adverse events. CONCLUSION: Patient self-management performed at least as well as usual care in maintaining the INR within the target range, without any safety concerns. This treatment modality for the long-term use of warfarin has the potential to change current local and international practice.

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Effects of computer-assisted oral anticoagulant therapy.

Journal Thrombosis journal
Year 2012
Liens Pubmed DOI PubMed Central

Cet article est inclus dans 1 Systematic review Systematic reviews (1 reference)

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Background: Computer-assistance and self-monitoring lower the cost and may improve the quality of anticoagulation therapy. The main purpose of this clinical investigation was to use computer-assisted oral anticoagulant therapy to improve the time to reach and the time spent within the therapeutic target range compared to traditional oral anticoagulant therapy by physicians.Methods: 54 patients were randomized equally into 3 groups. Patients in two groups used CoaguChek® systems to measure international normalized ratio (INR) values and had dosages of anticoagulation treatment calculated in a computer system by an algorithm specific to each group. The third group received traditional anticoagulation treatment by physicians. The obtained INR values were compared regarding the time to reach, and the time spent within, the therapeutic target range, corresponding to INR values from 2 to 3.Results: Patients randomized to computer-assisted anticoagulation and the CoaguChek® system reached the therapeutic target range after 8 days compared to 14 days by prescriptions from physicians (p = 0.04). Time spent in the therapeutic target range did not differ between groups. The median INR value measured throughout the study from all patients by CoaguChek® at 2.5 (2.42-2.62) was lower than measured by a hospital-based Clinical and Biochemical Laboratory at 2.6 (2.45-2.76), (p = 0.02).Conclusions: The therapeutic target range was reached faster by the use of computer-assisted anticoagulation treatment than prescribed by physicians, and the total time spent within the therapeutic target range was similar. Thus computer-assisted oral anticoagulant therapy may reduce the cost of anticoagulation therapy without lowering the quality. INR values measured by CoaguChek® were reliable compared to measurements by a clinical and biochemical laboratory. © 2012 Rasmussen et al.; licensee BioMed Central Ltd.

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Impact d'un pharmacien dirigé par la warfarine programme d'autogestion de la qualité de la vie et de contrôle de l'anticoagulation: un essai randomisé.

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Journal Pharmacotherapy
Year 2012
Liens Pubmed DOI

Cet article est inclus dans 1 Systematic review Systematic reviews (1 reference)

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Objectif de l'étude: évaluer l'impact d'un pharmacien-patient, dirigé par la warfarine programme d'autogestion de la qualité de la vie et de contrôle de l'anticoagulation par rapport à la gestion d'une clinique médicale dirigée par anticoagulation spécialisée. SCHÉMA: Etude prospective, randomisée, contrôlée, en ouvert procès. CONTEXTE: soins tertiaires centre médical universitaire. Patients: Un total de 114 patients âgés de 18-75 ans qui ont été suivis dans une clinique d'anticoagulation spécialisée, avait reçu de la warfarine pendant au moins 6 mois, et devaient se poursuivre warfarine pour un minimum de 4 mois. INTERVENTION: Tous les patients ont assisté à une séance d'information sur l'anticoagulation fournis par un pharmacien. Les patients randomisés dans le groupe d'auto-gestion (58 patients) ont également reçu une formation pratique d'utiliser l'appareil CoaguChek XS et un algorithme de dosage de l'autogestion. Les patients du groupe témoin (56 patients) ont continué à subir la gestion standard à la clinique d'anticoagulation. MESURES ET RÉSULTATS PRINCIPAUX: Les patients ont rempli un validé la qualité de vie et le questionnaire validé Epreuve orale des connaissances anticoagulation au début et à la fin de l'étude. La qualité du contrôle de l'anticoagulation a été évaluée en utilisant le temps passé dans l'intervalle thérapeutique. Après 4 mois de suivi, une amélioration significative dans le groupe d'auto-gestion a été observée par comparaison avec le groupe témoin dans quatre des cinq de la qualité de vie des sujets (p <0,05). L'amélioration des connaissances ont été observées dans les deux groupes après la session de formation et a persisté après 4 mois (p <0,05 pour tous). Le temps passé dans la zone thérapeutique (80,0% dans le groupe autogestion vs 75% dans le groupe témoin, p = 0,79) et dans la gamme étendue thérapeutique ([rapport international normalisé ± 0,3] 93,2% dans l'auto-gestion groupe vs 91,1% dans le groupe témoin, p = 0,30) étaient similaires entre les groupes. Conclusion: Un programme d'auto-gestion de la warfarine dirigée par des pharmaciens a entraîné une amélioration significative de la qualité de vie des patients traités par la warfarine ainsi que d'une réduction du temps nécessaire pour surveillance de l'anticoagulation, tout en maintenant un niveau de contrôle de l'anticoagulation semblable à un haut- clinique d'anticoagulation spécialisés de qualité.

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Self-management of oral anticoagulation in elderly patients - effects on treatment-related quality of life.

Journal Thrombosis research
Year 2012
Liens Pubmed DOI

Cet article est inclus dans 1 Systematic review Systematic reviews (1 reference)

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UNLABELLED: BACKGROUND - RATIONALE FOR STUDY: In elderly patients, long-term self-management of oral anticoagulation has been shown to reduce the number of major thromboembolic and bleeding complications and improve the quality of oral anticoagulation (OAC) control compared to routine care for a mean follow-up period of three years. This article presents the results of the predefined secondary endpoint treatment-related quality of life (QoL). METHODS AND RESULTS: The effect of self-management on five aspects of QoL was evaluated in comparison with routine care. A validated questionnaire specifically designed for patients receiving OAC was used. The evaluation was possible for 141 patients, comprising 90% of surviving patients on OAC. At baseline, all patients had high scores for the following QoL-aspects: general treatment satisfaction, self-efficacy, daily hassles and strained social network. A high proportion of patients in both groups explicitly reported high distress, indicating that general psychological distress seems to be of particular concern in this population. After about 3 years of follow-up, patients performing self-management showed a significantly greater improvement in general treatment satisfaction than controls (median score increase [25th percentile, 75th percentile]: 0.9 [0.0, 1.6] vs. 0.0 [-0.2, 0.6], p=0.002; scale 1-6). Changes in general psychological distress, self-efficacy, daily hassles and strained social network were not significant. CONCLUSION: Treatment related quality of life in elderly patients performing self-management of OAC was similar as for patients in routine care setting, with a tendency of higher general treatment satisfaction, after three years of follow up.

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Results of the first randomized French study evaluating self-testing of the International Normalized Ratio.

Journal The Journal of heart valve disease
Year 2011
Liens Pubmed

Cet article est inclus dans 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND AND AIM OF THE STUDY: In this single-center French study, the conventional management of patients receiving vitamin K antagonists (VKAs) was compared with an International Normalized Ratio (INR) self-testing program. The aim was to determine the reliability of self-testing devices, and to estimate the variability of the self-measured INR within the therapeutic and target range. METHODS: A total of 206 patients who had undergone valve replacement with a mechanical prosthesis, with or without myocardial revascularization, between May 2004 and September 2007 was randomized into two groups. Group 1 patients (n = 103) underwent INR monitoring at a laboratory, while Group 2 patients (n = 103) underwent self-testing INR using either the CoaguChek (Roche) (Group 2A; n = 55) or INRatio (Hemosense) (Group 2B; n = 48) system. Patients in Group 1 underwent at least once-monthly INR measurement, while those in Group 2 carried out once-weekly self-testing, and also underwent once-monthly INR measurement at the laboratory. The large majority of patients (97.9%) were treated with fluindione. RESULTS: The mean follow up period was 49.0 +/- 10.3 weeks. Self-testing was reliable, with a correlation coefficient between device- and laboratory-measured INRs of 0.80 [CI: 0.78, 0.82] (p < 0.0001). The proportion of time spent within the INR target range was significantly higher for Group 2 (61.5 +/- 19.3% versus 55.5 +/- 19.9%; p < 0.05), while the absolute mean deviation of INR from the target range was higher in Group 1 (60.1 +/- 70.2% versus 47.4 +/- 51.5%). Adverse events were reported by seven patients in Group 1, but by no patients in Group 2 (p < 0.01). CONCLUSION: INR self-testing devices are reliable and beneficial. Moreover, INR self-monitoring allows an enhanced stability within a target range, and also helps to prevent serious postoperative complications.

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Home management of oral anticoagulation via telemedicine versus conventional hospital-based treatment.

Journal Telemedicine journal and e-health : the official journal of the American Telemedicine Association
Year 2011
Liens Pubmed DOI PubMed Central

Cet article est inclus dans 3 Systematic reviews Systematic reviews (3 references)

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BACKGROUND AND OBJECTIVE: We have developed an expert computer system for the control of oral anticoagulation therapy, accessible by the patients via their own computer. To investigate if the weekly measurement and dosing of international normalized ratio (INR) at home using the online Internet-based system was superior to conventional treatment, we performed a randomized, controlled trial. PATIENTS AND METHODS: All 669 patients in our anticoagulation clinic were asked to participate in the trial, providing that they had Internet access and could use the CoaguChek XS system. A total of 140 patients were included and randomized to (A) once weekly measurement and report online, (B) twice weekly measurement and report online, and (C) continued conventional treatment with INR measurement in the lab every 4 weeks and dose adjustment by letter. RESULTS: Group A had 79.7% (95% CI 79.0-80.3) of time in therapeutic range (TTR), group B 80.2% (95% CI 79.4-80.9) of TTR, and group C 72.7% (95% CI 71.9-73.4) TTR. Groups A and B perform statistically significantly better than the conventional group C, with a difference of TTR of 7% points (p < 2.2 × 10(-16)), whereas no difference was seen between A and B. CONCLUSION: Home measurement of INR and the reporting and dosing of results online once a week increase TTR from 72% to 79% as compared to conventional computer-assisted monitoring in an anticoagulation clinic.

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Does self-management of oral anticoagulation therapy improve quality of life and anxiety?

Journal Family practice
Year 2011
Liens Pubmed DOI

Cet article est inclus dans 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: Research related to service requirements for anticoagulation management has focussed on clinical and health economic outcomes and paid little attention to the impact of treatment and service delivery on patients' quality of life. This was the first large UK study to evaluate the effect of patient self-management (PSM) of oral anticoagulation on treatment-related quality of life (TRQoL) and anxiety in comparison with routine care (RC) and to explore the effect of level of therapeutic control on TRQoL and anxiety across and within each model of care. METHODS: A quantitative survey, set in primary care in the West Midlands. The subjects were 517 randomized controlled trial participants, 242 receiving PSM and 275 RC. Postal questionnaires at baseline and 12 months comprised the State Trait Anxiety Inventory and a treatment-specific measure of positive (satisfaction and self-efficacy) and negative aspects (daily hassles, strained social network and psychological distress) of TRQoL. Change in anxiety and TRQoL scores were compared between PSM and RC. Subgroup analysis was based upon level of therapeutic control (high, medium and low). RESULTS: Overall, 83% (n = 202) PSM and 55% (n = 161) RC patients contributed data. Anxiety scores were similar in both groups. PSM demonstrated greater improvement in self-efficacy than RC across the study period. A statistically significant between-group difference (PSM versus RC) in the self-efficacy also existed in subgroups with medium and high levels of therapeutic control. CONCLUSIONS: PSM is not associated with increased anxiety and has a positive effect upon some aspects of TRQoL compared to RC.

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Patient self-management of warfarin therapy: pragmatic feasibility study in Canadian primary care.

Auteurs Grunau BE , Wiens MO , Harder KK
Journal Canadian family physician Medecin de famille canadien
Year 2011
Liens Pubmed PubMed Central

Cet article est inclus dans 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: To investigate the effectiveness of patient self-management (PSM) of anticoagulation using warfarin in a typical primary care site in Canada and to determine the feasibility of conducting a future large-scale trial in this setting. DESIGN: An 8-month pragmatic open-label randomized crossover trial. SETTING: A typical Canadian primary care practice in British Columbia. INTERVENTION: Patients were randomized to PSM or physician management for 4 months, after which allocation was reversed. The PSM group members were instructed to monitor their serum international normalized ratio (INR) at community laboratories and to adjust their warfarin doses independently using provided nomograms. Education on warfarin dose adjustment was limited to a single 15-minute office visit. MAIN OUTCOME MEASURES: The primary outcome was the proportion of INR values in the therapeutic range among participants. Feasibility outcomes included proportion of eligible patients consenting, patients' preference of management strategy, patients' satisfaction, and visits or phone communication with physicians regarding dose adjustment. Safety outcomes included bleeding or thromboembolic events. RESULTS: Eleven patients completed the trial, contributing 99 patient-months of monitoring and providing 122 INR measures. The mean proportion of INR values in therapeutic range among subjects in the PSM and physician-management groups was 82% and 80%, respectively (P = .82). The improvement in patient satisfaction with PSM was not significant. Ten of the 11 patients preferred PSM to physician management and elected to continue with this strategy after study completion (P = .001). No calls or visits were made to the physician regarding dose adjustment during the PSM period. There were no episodes of major bleeding or thromboembolic events. CONCLUSION: Patient self-management was not demonstrated to be superior to standard care, but was easily implemented and was the method preferred by patients. Our feasibility outcomes justify a larger trial and suggest that subject recruitment and protocol adherence would not pose barriers for such a study. Trial registration number NCT00925028 (ClinicalTrials.gov).