Are patients on oral anticoagulation therapy aware of its effects? A cross-sectional study from Karachi, Pakistan

Development and validation of the Chinese oral anticoagulants knowledge tool (C-OAKT): A pilot study

Objective

To develop and validate an oral anticoagulant knowledge tool for Chinese-speaking patients treated with warfarin or direct oral anticoagulants (DOACs) in Hong Kong.

Method

This pilot validation study consisted of the following three phases: (1) the development of a knowledge tool and content validity assessment; (2) a pilot study of 200 participants, consisting of 100 patients taking warfarin or DOACs, 50 pharmacists, and 50 members of the general public; and (3) known-group validity and reliability assessments.

Results

A 19-item "Chinese Oral Anticoagulants Knowledge Tool (C-OAKT)" was developed with a scale content validity index of 0.95. The mean score for known-group validity was significantly higher in the pharmacist group than the patient groups, and the patient groups scored significantly higher than the general public (mean ± standard deviation [SD] = 90.00 ± 7.11 vs. 51.55 ± 17.49 vs. 19.0 ± 15.42, respectively; p < 0.001). The mean score was higher for patients who attended a pharmacist-managed anticoagulant therapy management clinic (PAC) than for non-PAC patients (mean ± SD = 56.80 ± 13.60 vs. 46.30 ± 9.43; p = 0.004). An analysis of internal consistency showed a Cronbach's alpha value of 0.86.

Conclusion

The results of the pilot validation study suggested that the C-OAKT is a valid and reliable instrument for assessing patients' knowledge of oral anticoagulants in ambulatory care settings.

Innovations

This is the first validated Chinese version of an anticoagulant knowledge assessment tool. This tool will be utilized in public hospitals in Hong Kong, and will facilitate future research exploring the relationship between anticoagulant knowledge and patient-related outcomes.

Assessing the knowledge of medical undergraduates on oral anticoagulation therapy

Objective

Oral anticoagulant drugs, such as warfarin, are widely used for preventing and treating vascular and thromboembolic disease in patients with chronic atrial fibrillation, venous thrombosis, and coronary heart disease. As oral anticoagulant therapy has such a narrow therapeutic range, complications in administering these drugs can prove to have a detrimental effect on patients such as life-threatening bleeding might occur. It is therefore necessary to have an adequate knowledge about its actions and its interactions with other dietary factors or any other medication involved. This study was therefore formulated in order to evaluate the knowledge as well as to impart proper awareness to the medical undergraduate students about oral anticoagulation therapy such as to prevent any untoward situation that may arise from the process.

Methods

A cross-sectional descriptive study was used to assess the knowledge on oral anticoagulant therapy among the medical undergraduates of a tertiary care hospital. A pre-validated structured questionnaire consisting of 28 questions was adopted, and a separate questionnaire was used for each student. Timing of answering the questionnaire was set at 30 minutes. Scores were evaluated such as a correct answer was given a score of one and wrong answer awarded as zero. Adequate knowledge sore was set above 70% and inadequate knowledge at less than 40%.

Results

The response rate was found out to be 67.33% with gender distribution observed to be 71% females and 29% males. From the answers evaluated, overall average score of 67.3 ± 15.9 was obtained indicating that most of the respondents have adequate knowledge about the different mechanism, drug-drug interactions, drug-food interactions, and side effects of anticoagulant therapy, and 100% of the students are well aware about the complications and procedures involved to dissipate information about warfarin therapy.

Conclusions

Adequate exposure of students to clinical cases will further help them to focus on the importance of anticoagulation and strengthening their knowledge regarding anticoagulant drug therapy. This will influence the process of physician-patient communication for improving anticoagulation outcome.

Electrophysiology practice in low- and middle-income countries: An updated review on access to care and health delivery

Concurrent with the epidemiological transition to cardiovascular diseases in low- and middle-income countries (LMICs), the burden of arrhythmias is increasing significantly. However, registries of electrophysiological disorders and their management in LMICs are limited. The advancement of telemedicine technology can play a distinctive role in providing accurate diagnoses in resource-limited settings. The estimated pacemaker implantation requirements (1 million per year) demand an alternate source of pacemakers, including reused permanent pacemakers and implantable cardioverter-defibrillators. In addition, the majority of supraventricular tachycardias and atrial fibrillation can be managed with radiofrequency ablation, which not only is cost-effective but is curative for most patients.

Deep Venous Thrombosis and Pulmonary Embolism Secondary to Mild Traumatic Injury in an Elderly Male With No Additional Risk Factors

Venous thromboembolism (VTE) is a significant cardiovascular disease with a relatively high incidence rate, presenting a significant clinical burden. Its effective diagnosis and treatment are critical to the proper management of patients with the condition. Though there are several risk factors associated with VTE, advanced age itself presents as particularly significant, with age-related risk alone leading to high incidences of VTE in elderly patients even in the absence of other risk factors or relevant medical history. We present such a case of an elderly male patient with limited risk factors beyond advanced age who nonetheless presented with symptoms of deep-vein thrombosis (DVT) following a mild traumatic injury, and upon further inspection, was found to have a pulmonary embolism (PE). Proper precautions taken in assessing potential PE upon initial discovery of DVT and post-diagnostic management were critical in this patient's outcome.

Effectiveness of a Nursing Intervention Module on Adherence, Knowledge, Quality of Life, and Complications Among Patients Receiving Anticoagulation therapy-a Randomized Controlled Trial Protocol

BACKGROUND

Cardiovascular diseases are one of the major causes of mortality at the global level. They account for approximately 17.9 million deaths per year. Warfarin and acenocoumarol are the commonly used oral anticoagulants to treat and prevent thromboembolic disorders in patients with cardiovascular diseases. In India, approximately 2-2.5 million patients with rheumatic heart disease are receiving oral anticoagulation therapy. Additionally, this therapy is provided for stroke prevention in the case of atrial fibrillation and the treatment of valvular heart disease, stroke, and deep vein thrombosis. As the therapeutic range of these drugs is narrow and is affected by many factors, their use is challenging. This study aims to evaluate the effectiveness of a nursing intervention module in terms of adherence to therapy, knowledge, quality of life, and complications among patients receiving oral anticoagulation therapy. Furthermore, this study will address factors that affect adherence and the risk for bleeding by using a randomized controlled trial design.

METHODS

This single-blind, single-center, randomized controlled trial will focus on adherence to oral anticoagulation therapy. A total of 320 patients who are on oral anticoagulation therapy will be randomized into blocks and allocated to either the intervention or standard care group. The intervention will comprise the use of a nursing intervention module that includes a booklet, log sheet, and decision aid on oral anticoagulation therapy adherence. Outcome measures, that is, knowledge regarding oral anticoagulation therapy, adherence, complications, and quality of life, will be assessed at the baseline and during follow-ups.

DISCUSSION

Patient safety can be best achieved through patients' adherence to medication dose and monitoring of blood test values. Thromboembolic and bleeding complications are likely to occur when either the patient does not adhere to the treatment or the therapeutic range of the international normalized ratio is not maintained. This study will assess the nonadherence behavior and the effectiveness of a nursing intervention module toward adherence behavior.

TRIAL REGISTRATION

This research project is registered under the Clinical Trial Registry of India (CTRI/2019/06/019610).

Knowledge of Anticoagulation Among Saudi Patients With Atrial Fibrillation: A Cross-Sectional Study

Background Knowledge about oral anticoagulant treatment can impact treatment outcomes in patients with atrial fibrillation. However, evidence is scarce regarding the knowledge of oral anticoagulants among Saudi patients with atrial fibrillation. Hence, this study aimed to assess the level of anticoagulation knowledge among patients with atrial fibrillation taking oral anticoagulants. Methodology A survey using a cross-sectional study design was conducted among patients with a confirmed diagnosis of atrial fibrillation in a tertiary care setting. The Oral Anticoagulation Knowledge Tool (AKT), a 33-item, self-administered questionnaire, was used to assess the knowledge of anticoagulation. Results A total of 290 patients with a median age of 67 years participated in the survey. More than half of those surveyed (56.2%) were females. Overall, 195 (67.2%) patients had an overall adequate anticoagulation knowledge. The median knowledge score of participants on warfarin was significantly higher than those on direct-acting oral anticoagulants (p < 0.001). Only age was found to be a predictor of AKT. Increasing age was associated with fewer odds of adequate AKT. For every one-year increase in age, the knowledge score decreased by 0.08 (95% confidence interval: -0.13 to -0.04). Conclusions This study found significant knowledge gaps among Saudi patients with atrial fibrillation taking oral anticoagulants. Advancing age was inversely associated with oral anticoagulation knowledge.