Evaluation of venous thromboembolism risk following hospitalization.

Unlabelled: A better understanding of the relationship between outpatient venous thromboembolism (VTE) and prior hospitalization is needed including data regarding the utilization of inpatient pharmacologic VTE prophylaxis and its effect on outpatient venous thromboembolic risk. The primary objective was to assess the association between development of outpatient VTE and inpatient hospitalization within the previous 90 days. Additional outcome measures included describing patients who received pharmacologic anticoagulation during hospitalization and identification of factors independently associated with VTE.

Empiric warfarin dose adjustment with prednisone therapy. A randomized, controlled trial.

Typically, the international normalized ratio (INR) is monitored and warfarin dose adjusted, if necessary, to correct non-therapeutic INR after interacting medications, like prednisone, are initiated during warfarin therapy. Preemptively adjusting the warfarin dose is another approach. To evaluate the utility of preemptive warfarin dosage adjustment for preventing non-therapeutic INR following prednisone-warfarin co-administration.

Optimizing use of current anticoagulants.

Although warfarin has been the mainstay of oral anticoagulation therapy for decades, evidence-based methods for improving the quality of warfarin therapy remain underused. The arrival of new anticoagulants that do not require routine laboratory monitoring and lack the significant dietary and drug interaction potential that are seen with warfarin is an important evolutionary step in the management of thromboembolic disease. However, it will be years before the efficacy and long-term safety of these new agents are defined.

Oral vitamin K effectively treats international normalised ratio (INR) values in excess of 10. Results of a prospective cohort study.

Unanticipated elevation of the INR is common in patients receiving warfarin. We performed a prospective cohort study of 107 warfarin-treated patients with INR values of more than 10 who received a single 2.5 mg dose of oral vitamin K.

Twelve-month outcomes and predictors of very stable INR control in prevalent warfarin users.

Background: For patients on warfarin therapy an international normalized ratio (INR) recall interval not exceeding 4 weeks has traditionally been recommended. For patients whose INR values are nearly always therapeutic, less frequent INR monitoring may be feasible.

Objective: To identify patients with stable INRs (INR values exclusively within the INR range) and comparator patients (at least one INR outside the INR range), compare occurrences of thromboembolism, bleeding and death between groups, and identify independent predictors of stable INR control.

Unfractionated heparin dose requirements targeting intermediate intensity antifactor Xa concentration during pregnancy.

Study Objective: To describe unfractionated heparin (UFH) dosing requirements and monitoring parameters to achieve target antifactor Xa concentrations in pregnant women receiving intermediate-dose UFH therapy.

Design: Retrospective cohort analysis.

Setting: Centralized anticoagulation service in an integrated health care delivery system.

Incidence and predictors of bleeding or thrombosis after polypectomy in patients receiving and not receiving anticoagulation therapy.

Background And Aims: To assess the effect of warfarin anticoagulation therapy (AC) on the incidence of colon bleeding after elective colonoscopy with polypectomy and to identify independent predictors of post-polypectomy colon bleeding.

Methods: This was a retrospective cohort analysis. Patients interrupting warfarin AC therapy for polypectomy (AC group) were matched on age (+/- 3 years) with up to two patients who underwent polypectomy but were not receiving AC (non-AC group).

Natural history of mesenteric venous thrombosis in patients treated with vitamin K antagonists: a multi-centre, retrospective cohort study.

Knowledge on the natural history of mesenteric vein thrombosis (MVT) and of the efficacy and safety of long-term oral anticoagulant therapy (OAT) in this setting is based on small uncontrolled series of patients with a limited follow-up. It was the aim of the study to assess the natural history of MVT in a cohort of patients treated with OAT. The charts of all MVT patients currently attending or who have attended four anticoagulation clinics were reviewed.

Analysis of unfractionated heparin dose requirements to target therapeutic anti-Xa intensity during pregnancy.

Introduction: Unfractionated heparin (UFH) does not cross the placenta and has demonstrated utility in the prevention and treatment of thrombosis during pregnancy. Limited information is available to guide initiation and monitoring of therapeutic UFH targeting an anti-Xa concentration of 0.3-0.

Outcomes and predictors of very stable INR control during chronic anticoagulation therapy.

For patients on warfarin therapy, an international normalized ratio (INR) recall interval not exceeding 4 weeks has traditionally been recommended. Less frequent INR monitoring may be feasible in stable patients. We sought to identify patients with stable INRs (defined as having INR values exclusively within the INR range) and comparator patients (defined as at least one INR outside the INR range) in a retrospective, longitudinal cohort study.

Incidence of hemorrhage among anticoagulated patients receiving antiplatelet therapy after percutaneous coronary intervention.

This study aimed to compare major hemorrhage rates among patients receiving warfarin, acetylsalicylic acid (ASA), and clopidogrel to those receiving ASA and clopidogrel following percutaneous coronary intervention with stent implantation. This retrospective cohort study identified patients with stents implanted between September 1, 2003 and December 31, 2006. Patients treated with warfarin, ASA, and clopidogrel within 30 days of hospital discharge (Triple Therapy group) were matched by age, sex, and stent type to patients treated with ASA and clopidogrel (Dual Therapy group).

Oral vitamin K versus placebo to correct excessive anticoagulation in patients receiving warfarin: a randomized trial.

Background: Low-dose oral vitamin K decreases the international normalized ratio (INR) in overanticoagulated patients who receive warfarin therapy. Its effects on bleeding events are uncertain.

Objective: To see whether low-dose oral vitamin K reduces bleeding events over 90 days in patients with warfarin-associated coagulopathy.

Identification of copy number variants associated with BPES-like phenotypes.

Blepharophimosis-Ptosis-Epicanthus inversus syndrome (BPES) is a well-characterized rare syndrome that includes an eyelid malformation associated with (type I) or without premature ovarian failure (type II). Patients with typical BPES have four major characteristics: blepharophimosis, ptosis, epicanthus inversus and telecanthus. Mutations in the FOXL2 gene, encoding a forkhead transcription factor, are responsible for the majority of both types of BPES.

The Kaiser Permanente Colorado Clinical Pharmacy Anticoagulation Service as a model of modern anticoagulant care.

The Clinical Pharmacy Anticoagulation Service (CPAS) at Kaiser Permanente Colorado grew from a single pharmacist assisting a single physician to a comprehensive service staffed by over 20 employees. CPAS provides care for over 7200 patients with each CPAS pharmacist managing all aspects of anticoagulation therapy for 150 to 500 patients. Unique aspects of CPAS include its centralized organization structure, the use of telepharmacy, collaboration drug therapy management agreement with referring physicians and a robust research agenda.

Thromboembolic consequences of subtherapeutic anticoagulation in patients stabilized on warfarin therapy: the low INR study.

Study Objective: To quantify the absolute risk of thromboembolism associated with a significant subtherapeutic international normalized ratio (INR) in patients with previously stable anticoagulation while receiving warfarin.

Design: Retrospective, matched cohort analysis.

Setting: Centralized anticoagulation service in an integrated health care delivery system.

Evaluation of Iowa's graduated driver's licensing program.

The effectiveness of Iowa's graduated driver's licensing (GDL) program was evaluated for a 4-year period before and after implementation in 1999. Since some changes had occurred in the crash reporting format, changes in crash rates for younger drivers were compared to those for 35-44-year-old drivers (middle-age group of drivers) who were used as a control group. After implementation of GDL, the 14-, 16- and 17-year-old age groups experienced a greater decrease in crash rate than the middle-age control group while 15-year-old experienced a smaller decrease.

Delivery of optimized anticoagulant therapy: consensus statement from the Anticoagulation Forum.

Objective: To provide recommendations, policies, and procedures pertaining to the provision of optimized anticoagulation therapy designed to achieve desired clinical endpoints while minimizing the risk of anticoagulant-related adverse outcomes (principally bleeding and thrombosis).

Study Selection And Data Extraction: Due to this document's scope, the medical literature was searched using a variety of strategies. When possible, recommendations are supported by available evidence; however, because this paper deals with processes and systems of care, high-quality evidence (eg, controlled trials) is unavailable.

A descriptive evaluation of warfarin use in patients receiving hospice or palliative care services.

Purpose: To describe and compare warfarin therapy use and outcomes between warfarin-receiving patients in hospice or palliative care (HPC) and not in HPC.

Methods: This retrospective, matched analysis examined warfarin-receiving patients who did (study cohort) and did not receive (control cohort) HPC services between 2002 and 2005. The matched cohorts were compared on rates of international normalized ratio (INR) measurements, INR control, and warfarin-related adverse events.

A descriptive evaluation of unfractionated heparin use during pregnancy.

Background: The mainstay of oral anticoagulant therapy, warfarin sodium, crosses the placenta during pregnancy and may cause fetal complications. Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) do not cross the placenta and have demonstrated utility in the prevention and treatment of thrombosis during pregnancy.

Objectives: The purpose of this study was to review treatment strategy, indication, and maternal and fetal outcomes in anticoagulated pregnancies at Kaiser Permanente Colorado.