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Coumadin Protocol

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1. Protocolized use of Factor Eight Inhibitor Bypassing Activity (FEIBA) for the reversal of warfarin induced coagulopathy. (Abstract)

Protocolized use of Factor Eight Inhibitor Bypassing Activity (FEIBA) for the reversal of warfarin induced coagulopathy. Coagulopathy due to warfarin in patients with major bleeding was traditionally reversed with fresh frozen plasma and intravenous (IV) vitamin K, but prothrombin complex concentrates (PCC) are increasingly used in the treatment of these patients. Factor Eight Inhibitor Bypassing Activity (FEIBA) is an activated four-factor PCC most commonly used in patients with hemophilia. We (...) strategy and IV vitamin K.In 43 patients, median initial INR was 4.0 (2.7, 7.3 interquartile range (IQR)). Median time to result the second INR was 45 min (38, 55 IQR) and the median INR was 1.4 (1.3, 1.6 IQR). Out of the 43 patients, 93% achieved the target INR of ≤1.5. In-hospital mortality was 40% (17 patients). There were 11 TAEs in 6 patients (14%); 4 events in 2 patients (5%) were attributed to FEIBA.A protocolized use of FEIBA and IV vitamin K resulted in the efficacious reversal of warfarin

2019 American Journal of Emergency Medicine

2. Comparison of the outcomes of warfarin therapy and economics by online and offline anticoagulation management models: protocol for a randomised controlled trial. Full Text available with Trip Pro

Comparison of the outcomes of warfarin therapy and economics by online and offline anticoagulation management models: protocol for a randomised controlled trial. Warfarin is widely used in the world as oral anticoagulant, but it is difficult to manage patients after medication due to its narrow treatment window and individualised differences. Therefore, every region uses network means to carry out online anticoagulant therapy services. The purpose of this paper is to compare monitoring results (...) and randomised controlled studies of the complications of warfarin treated by offline or online management in a Chinese population.This is a randomised controlled, multicentre clinical trial. Taking the Union Hospital Affiliated to Fujian Medical University as the main centre, a randomised controlled study of several subcentres around China produced a nationally representative sample. 496 participants who took warfarin will be recruited and then randomly divided into two groups at a ratio of 1:1. We

2019 BMJ open

3. Protocol of a clinical trial study involving educational intervention in patients treated with warfarin. Full Text available with Trip Pro

Protocol of a clinical trial study involving educational intervention in patients treated with warfarin. Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. Oral anticoagulation is an effective strategy for primary and secondary prevention of stroke in patients with AF. Warfarin is an oral anticoagulant widely prescribed and, despite its benefits, the achievement of the goals of drug therapy depends on patient involvement, among other factors. Educational interventions (...) can contribute for effectiveness and safety of oral anticoagulation therapy. We sought to describe the protocol of a clinical trial designed to evaluate the effect of a patient-centered educational strategy focused on low-income patients with AF and poor anticoagulation control.Patients ≥18 years with AF, on warfarin for at least 6 months and time in therapeutic range (TTR) <60% will be recruited at 2 anticoagulation clinics (ACs) in Brazil. Patients from 1 AC will be allocated to the intervention

2019 Medicine

4. New warfarin anticoagulation management model after heart valve surgery: rationale and design of a prospective, multicentre, randomised trial to compare an internet-based warfarin anticoagulation management model with the traditional warfarin management m Full Text available with Trip Pro

New warfarin anticoagulation management model after heart valve surgery: rationale and design of a prospective, multicentre, randomised trial to compare an internet-based warfarin anticoagulation management model with the traditional warfarin management m Warfarin is an effective anticoagulant and the only oral anticoagulant available for patients with mechanical heart valves. The prothrombin time and the associated international normalised ratio (INR) are routinely tested to monitor (...) the response to anticoagulation therapy in patients. Patients who undergo mechanical heart valve replacement need lifelong anticoagulation therapy, and their INR is regularly measured to adjust the anticoagulation strength and the dose of anticoagulation drugs. Appropriate warfarin anticoagulation management can reduce patient complications, such as bleeding and thrombosis, and improve the long-term survival rate. We propose modern internet technology as a platform to build a warfarin anticoagulation

2019 BMJ open

5. Rationale, design, and protocol of a randomized controlled trial of the safety and efficacy of dabigatran etexilate versus dose-adjusted warfarin in patients with cerebral venous thrombosis. (Abstract)

Rationale, design, and protocol of a randomized controlled trial of the safety and efficacy of dabigatran etexilate versus dose-adjusted warfarin in patients with cerebral venous thrombosis. Rationale To prevent recurrent venous thrombotic events after acute cerebral venous or dural sinus thrombosis, guidelines recommend long-term oral anticoagulation with vitamin K antagonists. Non-vitamin K oral anticoagulant experience in cerebral venous or dural sinus thrombosis is limited to case reports (...) and series. Aim To compare dabigatran with dose-adjusted warfarin in patients with cerebral venous or dural sinus thrombosis for the prevention of recurrent venous thrombotic event. Sample size One hundred and twenty patients. Methods and design This study is a phase III, prospective, randomized, parallel-group, open-label, multicenter, exploratory trial with blinded endpoint adjudication. Patients with acute cerebral venous or dural sinus thrombosis after 5-15 days of treatment with parenteral heparin

2018 International journal of stroke : official journal of the International Stroke Society

6. Notification of international normalized ratio test in atrial fibrillation patients treated with warfarin via short message service: Study protocol for a randomized controlled trial Full Text available with Trip Pro

Notification of international normalized ratio test in atrial fibrillation patients treated with warfarin via short message service: Study protocol for a randomized controlled trial Atrial Fibrillation (AF) is the most common abnormal heart rhythm. AF patients usually use warfarin therapy. Safety and efficacy of warfarin are dependent on maintaining the International Normalized Ratio (INR) within the therapeutic range.We will use a Short Message Service (SMS) to evaluate the effect (...) of the control group will receive usual care without any SMS reminders. We will evaluate the effect of reminders on carrying out the INR test in a timely manner and maintaining the INR in the therapeutic range. Patients' follow-up will be done via telephone conversation to identify thromboembolic events, bleeding and mortality. The data will be analyzed by IBM SPSS version 24. We will use independent samples t-test or Mann-Whitney and Chi-square tests for the analyses of outcomes.This protocol describes

2017 Electronic physician Controlled trial quality: uncertain

7. Cost-effectiveness of warfarin care bundles for stroke prevention in patients with atrial fibrillation: a systematic review protocol

Cost-effectiveness of warfarin care bundles for stroke prevention in patients with atrial fibrillation: a systematic review protocol Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record

2020 PROSPERO

8. Improving inpatient warfarin therapy safety using a pharmacist-managed protocol Full Text available with Trip Pro

Improving inpatient warfarin therapy safety using a pharmacist-managed protocol Safe management of warfarin in the inpatient setting can be challenging. At the Mayo Clinic hospitals in Rochester, Minnesota, we set out to improve the safety of warfarin management among surgical and non-surgical inpatients.A multidisciplinary team designed a pharmacist-managed warfarin protocol (PMWP) which designated warfarin dosing to inpatient pharmacists with guidance from computerised dosing algorithms (...) . Ordering this protocol was ultimately designed as an 'opt out' practice. The primary improvement measure was frequency of international normalised ratio (INR) greater than 5; secondary measures included adoption rate of the protocol, a counterbalance INR metric (INR <1.7 three days after first inpatient warfarin dose), and complication rates, including bleeding and thrombosis events. An interrupted time series analysis was conducted to compare outcomes.Among over 50 000 inpatient warfarin recipients

2018 BMJ Open Quality

9. Impact of a Pharmacist-Driven Prothrombin Complex Concentrate Protocol on Time to Administration in Patients with Warfarin-associated Intracranial Hemorrhage Full Text available with Trip Pro

Impact of a Pharmacist-Driven Prothrombin Complex Concentrate Protocol on Time to Administration in Patients with Warfarin-associated Intracranial Hemorrhage Advancements in the treatment of warfarin-associated intracranial hemorrhage (ICH) include the use of four-factor prothrombin complex concentrate (4F-PCC), which has demonstrated more rapid reversal of the international normalized ratio (INR) when compared with fresh frozen plasma. A pharmacist-driven protocol for 4F-PCC was implemented (...) within our institution, which allows for pharmacist approval of 4F-PCC in patients diagnosed with warfarin-associated ICH and an INR ≥2. The pharmacist is responsible for determining the appropriate dose of 4F-PCC, preparation, bedside delivery, and order entry into the electronic medical record. Prior to implementation of the new protocol, the blood bank was responsible for 4F-PCC approval, dosing, product preparation, and arranging delivery with emergency department (ED) staff. The purpose

2018 Western Journal of Emergency Medicine

10. Postoperative bleeding of therapeutic endoscopy in patients using direct oral anticoagulant or warfarin: A systematic review and meta-analysis Full Text available with Trip Pro

Postoperative bleeding of therapeutic endoscopy in patients using direct oral anticoagulant or warfarin: A systematic review and meta-analysis Inplasy Protocol 194 - INPLASY.COM International Platform of Registered Systematic Review and Meta-analysis Protocols Main Menu Share this: Copyright © 2021 INPLASY.COM Powered by INPLASY.COM

2020 INPLASY - International Platform of Registered Systematic Review Protocols

11. Effect of Standardized Warfarin Treatment Protocol on Anticoagulant Effect: Comparison of a Warfarin Medication Therapy Adherence Clinic with Usual Medical Care Full Text available with Trip Pro

Effect of Standardized Warfarin Treatment Protocol on Anticoagulant Effect: Comparison of a Warfarin Medication Therapy Adherence Clinic with Usual Medical Care Objective: To evaluate the impact of pharmacist-led warfarin management and standardized treatment protocol. Methods: A retrospective cohort study was carried out in a cardiology referral hospital located in central Kuala Lumpur, Malaysia, from 2009 to 2014. The inclusion criteria were: adult patients who were diagnosed and treated (...) of the standardized protocol for the warfarin adherence clinic has not been assessed.What this study adds?• INR levels among UMC group and WMTAC group were significantly different.• Though the TTR level for the WMTAC group was not significantly different than the UMC group, it was higher and close to the targeted 60% level.• The identified findings show that pharmacists' focus on intervention for missed doses, adherence and dose adjustment provide positive impact on patients' warfarin therapy.

2017 Frontiers in pharmacology

12. Genetic factors associated with warfarin response in patients of black African ancestry: a systematic review and meta-analysis protocol

Genetic factors associated with warfarin response in patients of black African ancestry: a systematic review and meta-analysis protocol Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne

2018 PROSPERO

13. Warfarin Protocol

Protocol , Coumadin Protocol , Warfarin Reversal , Coumadin Reversal From Related Chapters II. Indications III. Management: INR variability See supplementation significantly helps stabilize INR levels 100-150 mcg orally daily Medical conditions that increase INR levels Disease Medical conditions that decrease INR levels IV. Protocol: Starting Warfarin in elderly inpatients ral Safe (no patient had an INR >4) Therapeutic INR achieved within 6-7 days Initial Dose: 4 mg daily for first 3 days Dosing (...) Warfarin Protocol Warfarin Protocol Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Warfarin Protocol Warfarin Protocol Aka: Warfarin

2018 FP Notebook

14. Warfarin use increases bleeding risk in hemodialysis patients with atrial fibrillation: protocol for a meta-analysis

Warfarin use increases bleeding risk in hemodialysis patients with atrial fibrillation: protocol for a meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence

2018 PROSPERO

15. Compare the clinical management of warfarin among physician versus pharmacist-led coagulation clinic: structured systematic review Full Text available with Trip Pro

by pharmacists on individual patient-centered outcomes. Keywords Pharmacist, Clinical pharmacy, Warfarin, services Introduction Warfarin was first introduced to the healthcare system in 1950 as Coumadin sodium [ ] for the management of Atrial Fibrillation (A-Fib), mechanical prosthetic heart valves, (DVT), coronary artery disease and stroke [ , ]. Warfarin exhibits serious adverse effects due to its Narrow Therapeutic Index (NTI) [ ] which might be life threatening due to the high individual variability (...) and confidence for better control on warfarin therapy [ , ]. Two studies also reported that the clinical pharmacists adjust the dose according to an established evidence based protocol, however the physician is usually influenced by his/her experience and clinical judgement. The physician changes the warfarin dose solely depending on the INR results with no further information on the patient health status. In contrast, the pharmacist-led services educate the patient on warfarin6, evaluate health status, life

2018 Biomedical Research

16. Warfarin Therapy - Management During Invasive Procedures and Surgery

Warfarin Therapy - Management During Invasive Procedures and Surgery Guidelines & Protocols Advisory Committee Warfarin Therapy – Management During Invasive Procedures and Surgery Effective Date: April 1, 2015 Scope This guideline provides recommendations for the management of warfarin therapy in adults aged = 19 years requiring invasive procedures and surgery. Perioperative management of non-vitamin K antagonist oral anticoagulants can be found in BCGuidelines.ca – Use of NOACs in Non-Valvular (...) Atrial Fibrillation. Non-perioperative management of warfarin is covered in BCGuidelines.ca – Warfarin Therapy Management. Key Recommendations • Warfarin discontinuation prior to invasive procedures is necessary for all interventional procedures except for minor skin procedures, routine dental work, cataract surgery, endoscopies without biopsy, and percutaneous venous access. • For elective procedures, warfarin should be stopped for 5 to 6 days prior to the procedure to allow gradual normalization

2015 Clinical Practice Guidelines and Protocols in British Columbia

17. Warfarin Therapy Management

Warfarin Therapy Management Guidelines & Protocols Advisory Committee Warfarin Therapy Management Effective Date: April 1, 2015 Scope This guideline provides recommendations for the long-term management of warfarin therapy in patients aged =19 years in the primary care setting. The guideline describes: 1) warfarin initiation, 2) international normalized ratio (INR) monitoring with optimal ranges, and 3) warfarin dosage adjustment. This guideline assumes the physician has reviewed (...) ). • Coumadin, www.coumadin.com, for patient information. • HealthLink BC, www.healthlinkbc.ca, for more information on warfarin and vitamin K. ? Appendices • Appendix A: Important Interactions with Warfarin ? Associated Documents The following documents accompany this guideline: • BCGuidelines.ca – Warfarin Therapy – Management During Invasive Procedures and Surgery • BCGuidelines.ca – Stroke and Transient Ischemic Attack – Acute and Long-Term Management • BCGuidelines.ca – Atrial Fibrillation – Diagnosis

2015 Clinical Practice Guidelines and Protocols in British Columbia

18. Comparison of outcomes in non-head injured trauma patients using pre-injury warfarin or direct oral anticoagulant therapy. (Abstract)

Comparison of outcomes in non-head injured trauma patients using pre-injury warfarin or direct oral anticoagulant therapy. Patients on prehospital anticoagulation with warfarin or direct oral anticoagulants (DOACs) represent a vulnerable subset of the trauma population. While protocolized warfarin reversal is widely available and easily implemented, prehospital anticoagulation with DOAC is cost prohibitive with only a few reversal options. This study aims to compare hospital outcomes of non (...) -head injured trauma patients taking pre-injury DOAC versus warfarin.A retrospective cohort study at a level 1 trauma center was performed. All adult trauma patients with pre-injury anticoagulation admitted between January 2015 and December 2018, were stratified into DOAC-using and warfarin-using groups. Patients were excluded if they had traumatic brain injury (TBI). Univariate and multivariable analyses were performed. Outcomes measures included in-hospital mortality, blood transfusion

2020 Injury

19. Comparative effectiveness and safety of direct oral anticoagulants compared to warfarin in morbidly obese patients with acute venous thromboembolism: systematic review and a meta-analysis Full Text available with Trip Pro

Comparative effectiveness and safety of direct oral anticoagulants compared to warfarin in morbidly obese patients with acute venous thromboembolism: systematic review and a meta-analysis Comparative effectiveness and safety of direct oral anticoagulants compared to warfarin in morbidly obese patients with acute venous thromboembolism: systematic review and a meta-analysis | SpringerLink Search Search SpringerLink Search Comparative effectiveness and safety of direct oral anticoagulants (...) compared to warfarin in morbidly obese patients with acute venous thromboembolism: systematic review and a meta-analysis Comparative effectiveness and safety of direct oral anticoagulants compared to warfarin in morbidly obese patients with acute venous thromboembolism: systematic review and a meta-analysis , , , , , & , ( 2020 ) 2340 Accesses 3 Citations 1 Altmetric Abstract Direct oral anticoagulant (DOAC) agents are becoming the anticoagulation strategy of choice. However, their use in the treatment

2020 Journal of thrombosis and thrombolysis

20. Advantages of a Warfarin Protocol for Long-term Care Pharmacists: a Retrospective Cohort Study Full Text available with Trip Pro

Advantages of a Warfarin Protocol for Long-term Care Pharmacists: a Retrospective Cohort Study Warfarin is an anticoagulant prescribed to 12% of long-term care residents to reduce the risk of thrombo-embolism. This study used indicators to compare warfarin management by pharmacists to usual care.This was a retrospective cohort study comparing a pharmacist-managed warfarin protocol with usual care of qualified warfarin recipients at long-term care facilities (two protocol, one control (...) ) in Calgary, Alberta. We compared the proportion of international normalized ratio (INR) tests in the range 2.0 to 3.0, time in range, number of tests, and frequency of bleeding at protocol and control sites. Our primary outcome, time in INR therapeutic range, is an indicator for assuring care quality. A cross-sectional survey at these sites compared health professionals' perceptions of workload and effectiveness of warfarin management.Of the 197 residents' charts reviewed in the study period, those

2016 Canadian Geriatrics Journal

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