مجال التميز

تميز دراسي وبحثي

البحوث المنشورة

البحث (1):

عنوان البحث:

Anticoagulation control and cost of monitoring of older patients on chronic warfarin therapy in three settings in North East England

رابط إلى البحث:

Click here

تاريخ النشر:

18 June 2014

موجز عن البحث:

Background: novel oral anticoagulants may be particularly cost-effective when INR control (TTR) with warfarin is poor or monitoring difficult

Setting: the Newcastle upon Tyne monitoring service, set in hospital or general practice and a domiciliary-based service for housebound patients

Objectives: to examine anticoagulation stability and costs of monitoring

Subjects: three hundred and twenty-six atrial fibrillation patients, 75 years and over, with target INR of two to three, accessing hospital (n = 100), general practice (n = 122) and domiciliary (n = 104) service

Methods: age, co-morbidities, length of warfarin treatment, medications, INR values and dose changes from January to December 2011 were recorded, and costs analysed

Results: home-monitored patients had taken warfarin for longer, mean 5.2 years, than hospital (3.7) or general practice (3.1) patients. Age and total number of drugs prescribed chronically were negatively related to TTR. INR measurements and dose changes were negatively associated with the duration of treatment, positively correlated with co-morbidities. The mean TTR was 78% in hospital, 71% in general practice and 68% in domiciliary monitored patients. INR was monitored more often in hospital and domiciliary groups than in general practice and more dose changes occurred in the domiciliary group than in others. Costs of warfarin and monitoring were £128 per patient per year for hospital, £126 for general practice and £222 for domiciliary patients

Conclusions: further exploration of the clinical effectiveness of novel anticoagulants in dependent patients is warranted to determine to what extent trial outcomes so far achieved in a fitter elderly population are influenced by the chronic co-morbidities of old age

المؤتمرات العلمية:

المؤتمر (1):

عنوان المؤتمر:

British Society For Haematology 54^th Annual Scientific Meeting

تاريخ الإنعقاد:

28-30 April 2014

مكان الإنعقاد:

Birmingham, UK

طبيعة المشاركة:

Poster presentation

عنوان المشاركة:

The impact of dietary vitamin K on the pharmacological activity of FXa inhibitor rivaroxaban in man

ملخص المشاركة:

The impact of dietary vitamin K intake on anticoagulation response to warfarin is well established. However, the effect of dietary vitamin K on the activity of the novel oral anticoagulants is less well known. We examined the influence of dietary vitamin K intake on the pharmacological activity of rivaroxaban in man ex-vivo

31 medically stable elderly inpatients (mean age 87±6 y) with a poor dietary intake and 28 healthy subjects (mean age 36±10 y) with adequate diets were studied. Each subject completed a validated dietary questionnaire for quantification of vitamin K content of foods eaten in the past week and provided a blood sample. The plasma samples were incubated with rivaroxaban (100 – 500 ng/ml). Normal prothrombin time (PT), modified prothrombin time (mPT), and vitamin K dependent clotting factors activity were measured according to established in-house methods

Rivaroxaban produced a greater prolongation of both PT (P=0.01) and mPT (P=0.02) in the plasma of elderly subjects than the younger healthy subjects over the drug concentration range studied. The mean difference in PT between the two groups ranged from 1.8s to 5.0s at 100 ng/ml and 500 ng/ml plasma rivaroxaban concentrations respectively. The mean difference in m-PT between the two groups ranged from 10.0s to 34.0s at 100 ng/ml and 500 ng/ml plasma rivaroxaban concentrations respectively. There was also a greater inhibition of factor Xa (P=0.005) activity by rivaroxaban in the elderly subjects compared to the healthy subjects, whereas factor IXa (P=0.03) activity was significantly inhibited in the healthy subjects compared to the elderly subjects. The analysis of dietary questionnaires showed that the healthy subjects consumed significantly higher amounts of vitamin K than the elderly ones (mean difference 150 µg; P<0.0001)

The present study findings demonstrated that the anticoagulation response to rivaroxaban may be influenced by poor dietary vitamin K intake