10 research outputs found
Improvement in the regulation of the vitamin K antagonist acenocoumarol after a standard initial dose regimen: prospective validation of a prescription model
Background In a retrospective study we have developed a model which determines the dose of acenocoumarol based on the age of the patient and on the first INR obtained after a standard initial loading dose. The group of patients of this study was used as the control group of the present study. Aim The aim of this study was to prospectively validate the model and to assess whether the use of this model improves the quality of the treatment in the 0-2 months study period. Patients and methods In 197 patients the model was evaluated by (1) in the initial phase: comparison of INRs with the control group, after assessing the dose according to the model, and (2) in the 0-2 months period: calculation of the percentage of time spent in the therapeutic target range compared to the control group. Furthermore, the eventual dose was compared to the dose of the model when the INRs were within the therapeutic target range for the first time and on two successive occasions. Results (1) When dosed according to the model, 50% of INRs in the total group were within the therapeutic target range compared to 45% in the control group, and (2) the percentage time spent within this range was 68 in the total group compared to 63 in the control group (P = 0.0013). When the INRs were within the range for the first time and successively twice, the eventual doses were similar to the model in 59 and 50%, respectively. About 20% of the patients did not achieve two successive INRs within the range. Conclusions Using the model the quality of treatment improved. We advice to use a standardized individualized dose regimen at the initiation of vitamin K antagonist treatmen
ΠΡΠΎΠ±Π»ΠΈΠ²ΠΎΡΡΡ ΡΠΌΡΠ½ΠΎ-Π³ΠΎΡΠΌΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠ° ΠΌΡΠΊΡΠΎΠ±ΡΠΎΠ»ΠΎΠ³ΡΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΡ Ρ ΠΆΡΠ½ΠΎΠΊ Π· ΡΡΠ·Π½ΠΈΠΌΠΈ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΡΡΠ½ΠΈΠΌΠΈ ΡΠΎΡΠΌΠ°ΠΌΠΈ ΠΏΠΎΠ»ΡΠΏΡΠ² Π΅Π½Π΄ΠΎΠΌΠ΅ΡΡΡΡ
ΠΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΎ 58 ΠΆΠ΅Π½ΡΠΈΠ½ Ρ ΠΏΠΎΠ»ΠΈΠΏΠ°ΠΌΠΈ ΡΠ½Π΄ΠΎΠΌΠ΅ΡΡΠΈΡ. ΠΡΡΠ²Π»Π΅Π½Ρ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ ΠΌΠΈΠΊΡΠΎΠ±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ
ΠΏΠ΅ΠΉΠ·Π°ΠΆΠ°, Π³ΠΎΡΠΌΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈ ΠΈΠΌΠΌΡΠ½Π½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΠ° Π² Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΠΎΡ ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΎΡΠΌ ΠΏΠΎΠ»ΠΈΠΏΠΎΠ² ΡΠ½Π΄ΠΎΠΌΠ΅ΡΡΠΈΡ.
ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ» Π²ΡΠ΄Π΅Π»ΠΈΡΡ Π³ΡΡΠΏΠΏΡ ΡΠΈΡΠΊΠ° ΠΏΠΎ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΏΠΎΠ»ΠΈΠΏΠΎΠ² ΡΠ½Π΄ΠΎΠΌΠ΅ΡΡΠΈΡ. ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΎ, ΡΡΠΎ
ΠΏΠΎΠ»ΠΈΠΏ ΡΠ½Π΄ΠΎΠΌΠ΅ΡΡΠΈΡ ΡΠ»Π΅Π΄ΡΠ΅Ρ ΡΠ°ΡΡΠΌΠ°ΡΡΠΈΠ²Π°ΡΡ Π½Π΅ ΠΊΠ°ΠΊ ΠΌΠ΅ΡΡΠ½ΡΠΉ ΠΏΡΠΎΡΠ΅ΡΡ, Π° ΠΊΠ°ΠΊ ΡΠ΅Π°ΠΊΡΠΈΡ ΡΠ½Π΄ΠΎΠΌΠ΅ΡΡΠΈΡ Π² ΠΎΡΠ²Π΅Ρ Π½Π°
ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠ΅ Π³ΠΎΡΠΌΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈ ΠΈΠΌΠΌΡΠ½Π½ΠΎΠ³ΠΎ Π³ΠΎΠΌΠ΅ΠΎΡΡΠ°Π·Π°, ΡΡΠΎ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎ ΡΡΠΈΡΡΠ²Π°ΡΡ ΠΏΡΠΈ Π²ΡΠ±ΠΎΡΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΡ
Π΄Π°Π½Π½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ58 women with endometrial polyps were investigated. Specific microflora and hormonal and immune status
depending on the morphological forms of endometrial polyps were found. The analysis performed allowed to
allocate risk groups according to development of endometrial polyp. It was shown that endometrial polyp shall be
considered as endometrial reaction in response to hormonal and immune homeostasis disorder, rather than local
process. This should be borne in mind when choosing treatment for this patholog
Coumarin anticoagulants and co-trimoxazole: avoid the combination rather than manage the interaction
OBJECTIVE: The objective of our study was to examine the management of the interaction between acenocoumarol or phenprocoumon and several antibiotics by anticoagulation clinics and to compare the consequences of this interaction on users of co-trimoxazole with those for users of other antibiotics. METHODS: A follow-up study was conducted at four anticoagulation clinics in The Netherlands. Data on measurements of the International Normalised Ratio (INR), application of a preventive dose reduction (PDR) of the coumarin anticoagulant, fever and time within or outside the therapeutic INR range were collected. RESULTS: The study cohort consisted of 326 subjects. A PDR was given more often to users of co-trimoxazole PDR than to users of other antibiotics. The PDR in co-trimoxazole users resulted in a significantly reduced risk of both moderate overanticoagulation (INR >4.5) and severe overanticoagulation (INR >6.0) compared with no PDR, with odds ratios (ORs) of 0.06 [95% confidence interval (CI): 0.01-0.51] and 0.09 (95% CI: 0.01-0.92), respectively. In co-trimoxazole users without PDR, the risk of overanticoagulation was significantly increased compared with users of other antibiotics. All co-trimoxazole users spent significantly more time under the therapeutic INR range during the first 6 weeks after the course than users of other antibiotics. CONCLUSION: PDR is effective in preventing overanticoagulation in co-trimoxazole users, but results in a significantly prolonged period of underanticoagulation after the course. Avoidance of concomitant use of co-trimoxazole with acenocoumarol or phenprocoumon seems to be a safer approach than management of the interaction between these drugs
Discrepancies between medication records of anticoagulation clinics and pharmacy records
PURPOSE: To determine whether there were discrepancies between with coumarin anticoagulants interacting medications recorded in medical files of anticoagulation clinics (AC-records) and computerized records of community pharmacies (pharmacy records). METHODS: A descriptive study was conducted at two Dutch anticoagulation clinics (AC's). Records of with coumarin anticoagulants interacting drugs at the AC's were compared with the pharmacy records. A drug registered in the pharmacy records but not in the AC-records, was recorded as a discrepancy, while a drug registered in AC-records as well as in pharmacy records, was recorded as a match. RESULTS: Of the 117 identified interacting drugs registered in pharmacy records 32 (27%) were not registered in the AC-records. In four out of seven patients of whom the use of a pharmacokinetically interacting drug was not registered in the AC-records, several INR-values exceeded the upper therapeutic range. CONCLUSION: This study demonstrates that a substantial percentage of drugs of which an interaction with coumarin anticoagulants can be expected, is not registered in the medical files of anticoagulation clinics
Invasive procedures in the outpatient setting: managing the short-acting acenocoumarol and the long-acting phenprocoumon
Treatment with vitamin K antagonists (VKAs) has to be interrupted when invasive procedures are planned. We compared various methods of interruption in patients on acenocoumarol or phenprocoumon in a prospective study. In patients on acenocoumarol (n = 141), 99 stopped three days before the intervention and 42 stopped two days before. All patients on phenprocoumon (n = 111) received vitamin K two days before the intervention, and 55 of these patients discontinued phenprocoumon, whereas 56 did not stop. In a subset of 30 patients we determined International Normalized Ratios (INRs) and coagulation factors II, VII, X and protein C. The mean INR after stopping acenocoumarol for three days was significantly lower than after two days (1.1 vs. 1.3, p = <0.0001), but its clinical relevance may be trivial. In patients using phenprocoumon, the mean INR on the day of the intervention was only slightly lower after stopping the VKAs (1.5 vs. 1.6, p = 0.0407), but a similar proportion of patients had an INR <or=1.4. On the day of the intervention, in the acenocoumarol group mean plasma levels of all coagulation factors were higher than 50% and in the phenprocoumon group higher than 25%. We conclude that acenocoumarol can be stopped two days before an invasive procedure that is associated with a low or moderate bleeding risk and three days before an intervention with a higher bleeding risk. For phenprocoumon, administration of vitamin K two days before an intervention results in an acceptable INR during the intervention, regardless whether phenprocoumon is interrupted or no
The influence on INRs and coagulation factors of the time span between blood sample collection and intake of phenprocoumon or acenocoumarol: consequences for the assessment of the dose
Managing treatment with vitamin K antagonists, the prothrombin time (PT), expressed as international normalized ratio (INR), may not represent the INR during the entire 24 hour (h) period, and this variation may be different between long-acting phenprocoumon and short-acting acenocoumarol. For both drugs we investigated the variation in 24 h of the PT/INR, the consequencesfor the assessment of the doses and which vitamin K-dependent factor causes the daily variation. Patients on self-management took their medication at 6 p.m. and determined their INRs for eight weeks, once a week and three times daily (8.30 a.m., 6 p.m. and 11 p.m., thus 14.5 h, 24 h and 29 h after taking the medication, respectively). Acenocoumarol showed a significant variation in INRs over the 24 h period, with 22 out of 80 INRs >20% lower at 11 p.m. versus 8.30 a.m. Phenprocoumon showed only few variations. Patients managed by the anticoagulation clinic took their medication at 6 p.m. for four weeks and then at 8 a.m. for four weeks, 15 h and 25 h, respectively, before the weekly blood collection. PT/INR and coagulation factors VII, X and II were determined. With acenocoumarol, taken 25 h before blood collection, the INRs were significantly different compared to 15 h, especially attributed to plasma levels of factor VII. Those on phenprocoumon were equal. These variations of INRs during 24 h may have major effects on the prescribed dose of short-acting vitamin K antagonists, such as acenocoumarol, especially for INRs at the limits of the therapeutic range
Improvement in the regulation of the vitamin K antagonist acenocoumarol after a standard initial dose regimen: prospective validation of a prescription model
Coumarin anticoagulants and co-trimoxazole: avoid the combination rather than manage the interaction
OBJECTIVE: The objective of our study was to examine the management of the interaction between acenocoumarol or phenprocoumon and several antibiotics by anticoagulation clinics and to compare the consequences of this interaction on users of co-trimoxazole with those for users of other antibiotics. METHODS: A follow-up study was conducted at four anticoagulation clinics in The Netherlands. Data on measurements of the International Normalised Ratio (INR), application of a preventive dose reduction (PDR) of the coumarin anticoagulant, fever and time within or outside the therapeutic INR range were collected. RESULTS: The study cohort consisted of 326 subjects. A PDR was given more often to users of co-trimoxazole PDR than to users of other antibiotics. The PDR in co-trimoxazole users resulted in a significantly reduced risk of both moderate overanticoagulation (INR >4.5) and severe overanticoagulation (INR >6.0) compared with no PDR, with odds ratios (ORs) of 0.06 [95% confidence interval (CI): 0.01-0.51] and 0.09 (95% CI: 0.01-0.92), respectively. In co-trimoxazole users without PDR, the risk of overanticoagulation was significantly increased compared with users of other antibiotics. All co-trimoxazole users spent significantly more time under the therapeutic INR range during the first 6 weeks after the course than users of other antibiotics. CONCLUSION: PDR is effective in preventing overanticoagulation in co-trimoxazole users, but results in a significantly prolonged period of underanticoagulation after the course. Avoidance of concomitant use of co-trimoxazole with acenocoumarol or phenprocoumon seems to be a safer approach than management of the interaction between these drugs
Discrepancies between medication records of anticoagulation clinics and pharmacy records
PURPOSE: To determine whether there were discrepancies between with coumarin anticoagulants interacting medications recorded in medical files of anticoagulation clinics (AC-records) and computerized records of community pharmacies (pharmacy records). METHODS: A descriptive study was conducted at two Dutch anticoagulation clinics (AC's). Records of with coumarin anticoagulants interacting drugs at the AC's were compared with the pharmacy records. A drug registered in the pharmacy records but not in the AC-records, was recorded as a discrepancy, while a drug registered in AC-records as well as in pharmacy records, was recorded as a match. RESULTS: Of the 117 identified interacting drugs registered in pharmacy records 32 (27%) were not registered in the AC-records. In four out of seven patients of whom the use of a pharmacokinetically interacting drug was not registered in the AC-records, several INR-values exceeded the upper therapeutic range. CONCLUSION: This study demonstrates that a substantial percentage of drugs of which an interaction with coumarin anticoagulants can be expected, is not registered in the medical files of anticoagulation clinics