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Romero-Arana A, González-Rodríguez MJ, Sánchez-Vega P, García-Iglesias JJ, Gómez-Salgado J, Romero A. [Educational program to improve knowledge and therapeutic range for self-controlled anticoagulated patients]. Aten Primaria 2025; 57:103139. [PMID: 39536414 PMCID: PMC11605452 DOI: 10.1016/j.aprim.2024.103139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 09/04/2024] [Accepted: 10/07/2024] [Indexed: 11/16/2024] Open
Abstract
INTRODUCTION Oral anticoagulation Self-control programs have demonstrated efficiency over recent years. OBJECTIVE The aim of the study was to evaluate the level of knowledge and coagulation level of self-controlled anticoagulated patients after an educational program. DESIGN A quasi-experimental study, pre-test and post-test. SITE: Health area of the Hematology Service of the Virgen de la Victoria University Hospital (Málaga, Spain). PARTICIPANTS Self-monitored anticoagulated patients. INTERVENTIONS Educational intervention about oral anticoagulation knowledge focused on patients that will initiate the self-control program in our consultation. MAIN MEASUREMENTS To check the patient's adherence and coagulation level, we evaluated the Rosendaal Time in Therapeutic Rank (TTRr), both before and after the intervention. RESULTS 145 patients have been included from 2016 to 2022 with a mean age of 49.18 years (SD 17.24). The mean score for the first test about knowledge was 14.61 (SD 3.26) and the mean score for the second test was 17.01 (SD 2.14) (p <0.001). Values before and after interventions were also statistically significant (67.46 vs 70.53, p<0.001). CONCLUSIONS The results showed that knowledge improved after the training session and the TTR values are better after the training which appears to be an effective action to improve the knowledge about oral anticoagulation in these patients.
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Affiliation(s)
- Adolfo Romero-Arana
- Servicio Andaluz de Salud, Distrito Sanitario Costa del Sol, Málaga, España; Instituto de Investigaciones Biomédicas de Málaga (IBIMA-Bionand), Málaga, España
| | | | - Patricia Sánchez-Vega
- Unidad de Tratamiento Anticoagulante, Hospital Valle del Guadalhorce, Cártama, Málaga, España
| | - Juan Jesús García-Iglesias
- Departamento de Sociología, Trabajo Social y Salud Pública, Facultad de Ciencias del Trabajo, Universidad de Huelva, Huelva, España
| | - Juan Gómez-Salgado
- Departamento de Sociología, Trabajo Social y Salud Pública, Facultad de Ciencias del Trabajo, Universidad de Huelva, Huelva, España; Programa de Posgrado en Seguridad y Salud, Universidad Espíritu Santo, Guayaquil, Ecuador.
| | - Adolfo Romero
- Instituto de Investigaciones Biomédicas de Málaga (IBIMA-Bionand), Málaga, España; Departamento de Enfermería y Podología, Facultad de Ciencias de la Salud, Universidad de Málaga, Málaga, España
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Romero-Arana A, González-Rodríguez MJ, Sánchez-Vega P, Gómez-Salgado J, Romero A. Effectiveness of a self-management program for anticoagulated patients to improve their knowledge about treatment and time in therapeutic range. Medicine (Baltimore) 2024; 103:e40258. [PMID: 39495974 PMCID: PMC11537636 DOI: 10.1097/md.0000000000040258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 10/08/2024] [Indexed: 11/06/2024] Open
Abstract
Oral anticoagulation self-control programs have demonstrated efficiency and cost-effectiveness over recent years. This study aimed to evaluate the effectiveness of a training intervention focused on patients with antivitamin K anticoagulants included in a self-care program. For this, we made a quasi-experimental study, pretest and post-test, using a validated questionnaire with 2 measures, before and after an educational intervention about oral anticoagulation focused on patients that will initiate the self-control program in consultation. To check the patient's adherence and coagulation level, we evaluated the Rosendaal time in therapeutic rank, both before and after the intervention. One hundred fifty patients were included since the start of the self-monitoring program in our center in 2016. The mean age was 49 years (standard deviation [SD] = 17.24). The distribution by gender was 76 women and 69 men (52.4%-47.6%). The mean score for the first test was 14.61 (SD = 3.26) and the mean score for the second test was 17.01 (SD = 2.14) (P <.001). We also measured Rosendaal time in therapeutic rank, a parameter that indicates stabilization in international normalized ratio determinations and quality of the anticoagulation management. Values before and after interventions were also statistically significant (67.46 vs 70.53, P <.001). Patients' knowledge improved after the training session, with statistical significance. Despite intentional sampling, the population was homogeneous. Scoring data dispersion in the second test was significantly lower than in the first one. Time on therapeutic rank values was better after the training. We intend to adapt its content to the rest of anticoagulated patients to enhance and improve their follow-up.
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Affiliation(s)
- Adolfo Romero-Arana
- Biomedical Research Institute of Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Distrito Sanitario Costa del Sol, Servicio Andaluz de Salud, Junta de Andalucía, Málaga, Spain
| | | | - Patricia Sánchez-Vega
- Anticoagulant Treatment Unit, Hospital Valle del Guadalhorce, Servicio Andaluz de Salud, Málaga, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Adolfo Romero
- Biomedical Research Institute of Málaga (IBIMA Plataforma BIONAND), Málaga, Spain
- Anticoagulant Treatment Unit, Hospital Valle del Guadalhorce, Servicio Andaluz de Salud, Málaga, Spain
- Department of Nursing and Podiatry, Health Sciences School, University of Málaga, Málaga, Spain
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Blanch P, Freixa-Pamias R, Gambau M, Lafuente R, Basile L. Impact of an oral anticoagulation self-monitoring and self-management program in patients with mechanical heart valve prosthesis. J Comp Eff Res 2021; 10:307-314. [PMID: 33594899 DOI: 10.2217/cer-2020-0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To analyze impact of implementation of an oral anticoagulation self-monitoring and self-management program among patients with mechanical valve prosthesis. Materials & methods: Observational and retrospective study performed in Hospital Moises Broggi, Barcelona, Spain. The program started on June 2019. The study compared 6-month period before and after the implementation of the program. Results: The study included 44 patients. There was a numerical increase of time in therapeutic range from 53.6 ± 21.3% to 57.1 ± 15.7% (p = 0.30). Proportion of patients with international normalized ratio (INR) >5 significantly decreased from 3.9 to 2.0% (p = 0.04). No significant differences were observed in thromboembolic or bleeding complications. Visits to emergency department decreased from (29.5 to 22.7%; p = 0.41). Conclusion: Oral anticoagulation self-monitoring and self-management program seems an appropriate approach that could provide additional benefits in selected patients with mechanical valve prosthesis.
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Affiliation(s)
- Pedro Blanch
- Department of Cardiology, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Román Freixa-Pamias
- Department of Cardiology, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Marta Gambau
- Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Raul Lafuente
- Department of Hematology, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Luca Basile
- Department of Cardiology, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain.,Public Health Agency of Catalonia, Generalitat de Catalunya, Barcelona, Spain
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Dai H, Zheng C, Lin C, Zhang Y, Zhang H, Chen F, Liu Y, Xiao J, Chen C. Technology-Based Interventions in Oral Anticoagulation Management: Meta-Analysis of Randomized Controlled Trials. J Med Internet Res 2020; 22:e18386. [PMID: 32673227 PMCID: PMC7391164 DOI: 10.2196/18386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/06/2020] [Accepted: 05/14/2020] [Indexed: 12/29/2022] Open
Abstract
Background An increasing number of patients have received prophylactic or therapeutic oral anticoagulants (OACs) for thromboembolic complications of diseases. The use of OACs is associated with both clinical benefits and risks. Considering the challenges imposed by this class of drugs, as well as the enormous progress made in portable device technology, it is possible that technology-based interventions may improve clinical benefits for patients and optimize anticoagulation management. Objective This study was designed to comprehensively evaluate the role of technology-based interventions in the management of OACs. Methods We searched 6 databases—PubMed, EMBASE, Cochrane, Cumulative Index to Nursing and Allied Health Literature, Scopus, and PsycINFO—to retrieve relevant studies published as of November 1, 2019, to evaluate the effect of technology-based interventions on oral anticoagulation management. RevMan (version 5.3; Cochrane) software was used to evaluate and analyze clinical outcomes. The methodological quality of studies was assessed by the Cochrane risk of bias tool. Results A total of 15 randomized controlled trials (RCTs) were selected for analysis. They reported data for 2218 patients (1110 patients in the intervention groups and 1108 patients in the control groups). A meta-analysis was performed on the effectiveness and safety data reported in the RCTs. Technology-based interventions significantly improved the effectiveness of oral anticoagulation management (mean difference [MD]=6.07; 95% CI 0.84-11.30; I2=72%; P=.02). The safety of oral anticoagulation management was also improved, but the results were not statistically significant. Bleeding events were reduced (major bleeding events MD=1.02; 95% CI 0.78-1.32; I2=0%; P=.90; minor bleeding events MD=1.06, 95% CI 0.77-1.44; I2=41%; P=.73) and thromboembolism events were reduced (MD=0.71; 95% CI 0.49-1.01; I2=0%; P=.06). In general, patients were more satisfied with technology-based interventions, which could also improve their knowledge of anticoagulation management, improve their quality of life, and reduce mortality and hospitalization events. Conclusions Using technology to manage OACs can improve the effectiveness and safety of oral anticoagulation management, result in higher patient satisfaction, and allow greater understanding of anticoagulation.
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Affiliation(s)
- Hengfen Dai
- Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, China
| | | | - Chun Lin
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Yan Zhang
- Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, China
| | - Hong Zhang
- Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, China
| | - Fan Chen
- Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, China
| | - Yunchun Liu
- Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, China
| | - Jingwen Xiao
- Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, China
| | - Chaoxin Chen
- School of Pharmacy, Fujian Medical University, Fuzhou, China
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Saksena D, Mishra YK, Muralidharan S, Kanhere V, Srivastava P, Srivastava CP. Follow-up and management of valvular heart disease patients with prosthetic valve: a clinical practice guideline for Indian scenario. Indian J Thorac Cardiovasc Surg 2019; 35:3-44. [PMID: 33061064 PMCID: PMC7525528 DOI: 10.1007/s12055-019-00789-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Valvular heart disease (VHD) patients after prosthetic valve implantation are at risk of thromboembolic events. Follow-up care of patients with prosthetic valve has a paramount role in reducing the morbidity and mortality. Currently, in India, there is quintessential need to stream line the follow-up care of prosthetic valve patients. This mandates the development of a consensus guideline for the antithrombotic therapy in VHD patients post prosthetic valve implantation. METHODS A national level panel was constituted comprising 13 leading cardio care experts in India who thoroughly reviewed the up to date literature, formulated the recommendations, and developed the consensus document. Later on, extensive discussions were held on this draft and the recommendations in 8 regional meetings involving 79 additional experts from the cardio care in India, to arrive at a consensus. The final consensus document is developed relying on the available evidence and/or majority consensus from all the meetings. RESULTS The panel recommended vitamin K antagonist (VKA) therapy with individualized target international normalized ratio (INR) in VHD patients after prosthetic valve implantation. The panel opined that management of prosthetic valve complications should be personalized on the basis of type of complications. In addition, the panel recommends to distinguish individuals with various co-morbidities and attend them appropriately. CONCLUSIONS Anticoagulant therapy with VKA seems to be an effective option post prosthetic valve implantation in VHD patients. However, the role for non-VKA oral therapy in prosthetic valve patients and the safety and efficacy of novel oral anticoagulants in patients with bioprosthetic valve need to be studied extensively.
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Nogueira F, Signorelli F, Levy RA. Antiphospholipid Syndrome On Cloud (APSOnCloud): web-based monitoring of oral anticoagulation. Lupus 2017; 26:179-185. [PMID: 27436335 DOI: 10.1177/0961203316658558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Antiphospholipid Syndrome (APS) is an autoimmune disease characterized by recurrent thromboses and fetal losses with the presence of antiphospholipid antibodies. The main treatment to prevent recurrent thrombotic events is oral anticoagulation with vitamin K antagonist (VKA), which requires frequent monitoring and dosage adjustments. Outpatient anticoagulation monitoring has its limitations, such as patients spending long hours between the testing procedure and waiting for the results to be adjusted. To optimize this adjustment and to improve APS patients-doctors relationship, we developed a website to help monitor APS patients, called Antiphospholipid Syndrome On Cloud or APSOnCloud. To test it, since March 2014 to March 2016, we registered 20 patients with APS that have inserted 132 international normalized ratio (INR) values. Sixty two percent were out of range and it took on average 7 hours for the doctor in charge to adjust these values. The mean time in therapeutic range was 58.1%. Our preliminary experience in monitoring VKA oral anticoagulation on APSOnCloud suggests that patients with APS might benefit from this web-based monitoring.
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Affiliation(s)
- F Nogueira
- 1 Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - F Signorelli
- 2 Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,3 Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - R A Levy
- 1 Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Siebenhofer A, Jeitler K, Horvath K, Habacher W, Schmidt L, Semlitsch T. Self-management of oral anticoagulation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:83-91. [PMID: 24622604 PMCID: PMC3953995 DOI: 10.3238/arztebl.2014.0083] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 10/16/2013] [Accepted: 10/16/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Properly dosed oral anticoagulation effectively prevents thromboembolic events. It is unclear whether adult patients with an indication for long-term oral anticoagulation can benefit from self-management in terms of patient-oriented endpoints and improved coagulation values. METHOD We selectively searched the Medline database for high-quality systematic reviews based on randomized controlled trials of self-measurement or self-management of oral anticoagulation, compared to standard treatment. RESULTS We identified eight review articles based on overlapping sets of ran - domized clinical trials. In all of these systematic reviews, patients who performed self-measurement or self-management had a 40% to 50% lower rate of thromboembolic events; in six of them, the mortality was also significantly lower, by 30% to 50%. Subgroup analysis revealed that these effects were present exclusively in patients who performed self-management, and not in those who only performed self-measurement. None of the review articles revealed any difference in the frequency of severe hemorrhagic events. Quality of life and patient satisfaction were rated in five reviews, which, however, used different instruments, with the result that no clear conclusions could be drawn. All of the review articles documented an improvement in coagulation values, but information on statistical significance was mostly lacking. CONCLUSION Adults with an indication for long-term oral anticoagulation benefit from self-management, as compared to standard treatment with management of dosing by a physician. A limitation of this study is that the multiple review articles on which it is based were largely analyses of the same group of clinical trials.
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Affiliation(s)
- Andrea Siebenhofer
- Institute of General Practice, J. W. Goethe University, Frankfurt/Main
- EBM Review Center, Medical University of Graz
| | - Klaus Jeitler
- EBM Review Center, Medical University of Graz
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz
| | - Karl Horvath
- EBM Review Center, Medical University of Graz
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz
| | - Wolfgang Habacher
- Institute of Biomedicine and Health Sciences (HEALTH), JOANNEUM RESEARCH Forschungsgesellschaft mbh, Graz
| | - Louise Schmidt
- Institute of Biomedicine and Health Sciences (HEALTH), JOANNEUM RESEARCH Forschungsgesellschaft mbh, Graz
| | - Thomas Semlitsch
- EBM Review Center, Medical University of Graz
- Institute of Biomedicine and Health Sciences (HEALTH), JOANNEUM RESEARCH Forschungsgesellschaft mbh, Graz
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