Overanticoagulation on coumarin anticoagulants

Most of the extensive research on oral anticoagulant therapy has focussed on its pharmacological- and biochemical action, prothrombin time calibration, optimal therapeutic intensity and hemorrhagic complications. However, whlle the risks of overanticoagulation are clear, its treatment and determinants have received little attention. Therefore, the aim of this thesis was to study aspects of overanticoagulation on coumarin anticoagulants among outpatients of an anticoagulation clinic. Overanticoagulation was defined as an INR:>6.0, since at this INR-value the risk of hemorrhage sharply increases (28, 41). Chapter 2 relates to the treatment of overanticoagulation and describes the course of the INR in response to oral vitamin K1 in overanticoagulated patients. Chapter 3 concerns the incidence of and risk factors for overanticoagulation and includes five studies. Chapter 3.1 focusses on characteristics of antic

Existing data sources for clinical epidemiology: The pharmo database network

The PHARMO Database Network provides a unique opportunity to gain insight in the complete patient journey and healthcare in the Netherlands. The PHARMO Database Network is a population-based network of electronic healthcare databases and combines anonymous data from different primary and secondary healthcare settings in the Netherlands. Healthcare settings include general practitioners, out-patient and in-patient pharmacies, hospitals and clinical laboratories. Furthermore, databases are linked with external registries suc

Astmabehandeling in de praktijk moeilijk vol te houden

Voor een effectieve behandeling is het belangrijk dat patiënten therapietrouw zijn. De geschatte therapietrouw voor astmamedicatie is echter laag, in de orde van 30-60%, ongeacht de gebruikte definities en methoden. Het doel van het huidige onderzoek was het beschrijven van de behandeling van astmapatiënten tijdens het eerste jaar (startbehandeling en eerste verandering), met de nadruk op de persistentie van het gebruik

Comparison of incidences of cardiovascular events among new users of different statins: a retrospective observational cohort study.

Item does not contain fulltextOBJECTIVE: To compare incidences of cardiovascular disease (CVD) in general and myocardial infarction (MI) specifically between new users of different statins in daily practice. DESIGN AND METHODOLOGY: Retrospective observational cohort study. Data were obtained from the PHARMO Record Linkage System; the PHARMO database contains pharmacy dispensing records of 3 million patients in the Netherlands registered with community pharmacies, linked to hospitalisation records. The participants were new statin users in the period 2000-2005, excluding patients hospitalised for CVD events in the year prior to start of statin use. MAIN OUTCOME MEASURES: Adjusted hazard ratios of hospitalisations for CVD (including any type of ischemic heart disease, stroke, or revascularisation procedure) in general, or MI in particular, occurring during use of the initial statin within two years of start of therapy, comparing users of different statins. RESULTS: The mean follow-up duration of 76,147 new statin users (14,530 pravastatin, 27,752 simvastatin, 25,777 atorvastatin, 8088 rosuvastatin) was 55 weeks. Incidence rates of CVD and MI per 100 person years ranged from 0.75 and 0.15 for rosuvastatin to 1.72 and 0.29 for pravastatin. Rosuvastatin users had a lower incidence rate of CVD compared to other statin users in general (28% lower), and simvastatin (29% lower) and pravastatin users (40% lower) in particular. The difference with atorvastatin was not statistically significant. Since this was not a prospective randomised study, there is the potential for unobserved risk factors to be responsible for some of the differences observed. CONCLUSION: Compared to other statin users without recent prior cardiovascular events, the incidence of fatal and non-fatal CVD in this retrospective observational cohort study was 28% lower among rosuvastatin users