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Anticoagulant management of atrial fibrillation: the influence of dosing algorithm and recall schedule on time in therapeutic range

Anticoagulant management of atrial fibrillation: the influence of dosing algorithm and recall... AbstractBackground.The quality of anticoagulation management in atrial fibrillation patients is reflected by the concept of time spent in therapeutic range (TTR). In a primary care setting, the implementation of a dose nomogram could help increase the mean TTR among these patients.Objective.This study compares the influence of a dose algorithm with an integrated recall on TTR prior to standard care and after the implementation of the protocol.Patients and methods.In a purposive sample of patients with AF, an uncontrolled ‘before’ and ‘after’ study design was utilized to measure the effects of the protocol on TTR. Demographic data, TTR levels, frequency of international normalized ratio (INR) within therapeutic range, clinician adherence to dose nomogram and warfarin dose changes were captured from consultations at the anticoagulation clinic.Results.A total of 152 patients with AF were entered into the final analysis. The increment in mean TTR in the ‘after’ intervention phase (2.9%) was not statistically significant (57.5–60.4%, P = 0.252). The increase in the frequency of INR values within therapeutic range in the ‘after’ intervention phase was significant (50.0–56.0%, P < 0.05) but with a very low effect size (r = 0.04).Conclusions.The implementation of a dose nomogram has the potential of reducing unnecessary dose changes for minor fluctuations in INR levels. The findings in this study needs to be confirmed in a future study involving other indications for anticoagulation, various regional primary care clinics and a larger population size. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Family Practice Oxford University Press

Anticoagulant management of atrial fibrillation: the influence of dosing algorithm and recall schedule on time in therapeutic range

Family Practice , Volume 32 (5) – Oct 1, 2015

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References (18)

Publisher
Oxford University Press
Copyright
© The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
ISSN
0263-2136
eISSN
1460-2229
DOI
10.1093/fampra/cmv066
pmid
26251026
Publisher site
See Article on Publisher Site

Abstract

AbstractBackground.The quality of anticoagulation management in atrial fibrillation patients is reflected by the concept of time spent in therapeutic range (TTR). In a primary care setting, the implementation of a dose nomogram could help increase the mean TTR among these patients.Objective.This study compares the influence of a dose algorithm with an integrated recall on TTR prior to standard care and after the implementation of the protocol.Patients and methods.In a purposive sample of patients with AF, an uncontrolled ‘before’ and ‘after’ study design was utilized to measure the effects of the protocol on TTR. Demographic data, TTR levels, frequency of international normalized ratio (INR) within therapeutic range, clinician adherence to dose nomogram and warfarin dose changes were captured from consultations at the anticoagulation clinic.Results.A total of 152 patients with AF were entered into the final analysis. The increment in mean TTR in the ‘after’ intervention phase (2.9%) was not statistically significant (57.5–60.4%, P = 0.252). The increase in the frequency of INR values within therapeutic range in the ‘after’ intervention phase was significant (50.0–56.0%, P < 0.05) but with a very low effect size (r = 0.04).Conclusions.The implementation of a dose nomogram has the potential of reducing unnecessary dose changes for minor fluctuations in INR levels. The findings in this study needs to be confirmed in a future study involving other indications for anticoagulation, various regional primary care clinics and a larger population size.

Journal

Family PracticeOxford University Press

Published: Oct 1, 2015

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