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1. Comparison of Patient‐Reported Care Satisfaction, Quality of Warfarin Therapy, and Outcomes of Atrial Fibrillation: Findings From the ORBIT‐AF Registry

Author

Alexander C. Perino, Peter Shrader, Mintu P. Turakhia, Jack E. Ansell, Bernard J. Gersh, Gregg C. Fonarow, Alan S. Go, Daniel W. Kaiser, Elaine M. Hylek, Peter R. Kowey, Daniel E. Singer, Laine Thomas, Benjamin A. Steinberg, Eric D. Peterson, Jonathan P. Piccini, and Kenneth W. Mahaffey

Subjects
anticoagulation, atrial fibrillation, patient‐reported outcome, patient‐centered care, warfarin, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Patient satisfaction with therapy is an important metric of care quality and has been associated with greater medication persistence. We evaluated the association of patient satisfaction with warfarin therapy to other metrics of anticoagulation care quality and clinical outcomes among patients with atrial fibrillation (AF). Methods and Results Using data from the ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry, patients were identified with AF who were taking warfarin and had completed an Anti‐Clot Treatment Scale (ACTS) questionnaire, a validated metric of patient‐reported burden and benefit of oral anticoagulation. Multivariate regressions were used to determine association of ACTS burden and benefit scores with time in therapeutic international normalized ratio range (TTR; both ≥75% and ≥60%), warfarin discontinuation, and clinical outcomes (death, stroke, major bleed, and all‐cause hospitalization). Among 1514 patients with AF on warfarin therapy (75±10 years; 42% women; CHA2DS2‐VASc 3.9±1.7), those most burdened with warfarin therapy were younger and more likely to be women, have paroxysmal AF, and to be treated with antiarrhythmic drugs. After adjustment for covariates, ACTS burden scores were independent of TTR (TTR ≥75%: odds ratio, 1.01 [95% CI, 0.99–1.03]; TTR ≥60%: odds ratio, 1.01 [95% CI, 0.98–1.05]), warfarin discontinuation (odds ratio, 0.99; 95% CI, 0.97–1.01), or clinical outcomes. ACTS benefit scores were also not associated with TTR, warfarin discontinuation, or clinical outcomes. Conclusions In a large registry of patients with AF taking warfarin, ACTS scores provided independent information beyond other traditional metrics of oral anticoagulation care quality and identified patient groups at high risk for dissatisfaction with warfarin therapy.

Published
2019
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2. Pharmacotherapy for Atrial Fibrillation in Patients With Chronic Kidney Disease: Insights From ORBIT‐AF

Author

Jeffrey B. Washam, DaJuanicia N. Holmes, Laine E. Thomas, Sean D. Pokorney, Elaine M. Hylek, Gregg C. Fonarow, Kenneth W. Mahaffey, Bernard J. Gersh, Peter R. Kowey, Jack E. Ansell, Alan S. Go, James A. Reiffel, James V. Freeman, Daniel E. Singer, Gerald Naccarelli, Rosalia Blanco, Eric D. Peterson, and Jonathan P. Piccini

Subjects
antiarrhythmic, anticoagulation, atrial fibrillation, chronic kidney disease, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Chronic kidney disease (CKD) is a common comorbidity in patients with atrial fibrillation. The presence of CKD complicates drug selection for stroke prevention and rhythm control. Methods and Results Patients enrolled in ORBIT AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) with baseline renal function and follow‐up data were included (N=9019). CKD was defined as an estimated creatinine clearance

Published
2018
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3. Therapeutic Strategies Following Major, Clinically Relevant Nonmajor, and Nuisance Bleeding in Atrial Fibrillation: Findings From ORBIT‐AF

Author

Emily C. O'Brien, DaJuanicia N. Holmes, Laine Thomas, Gregg C. Fonarow, Peter R. Kowey, Jack E. Ansell, Kenneth W. Mahaffey, Bernard J. Gersh, Eric D. Peterson, Jonathan P. Piccini, and Elaine M. Hylek

Subjects
anticoagulation, atrial fibrillation, bleeding, risk stratification, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Oral anticoagulation (OAC) reduces stroke risk in atrial fibrillation, but bleeding is a frequent side effect. The decision to discontinue or modify medication regimens in response to a bleeding event may differ according to bleeding site and severity. Methods and Results We used data from a large, national outpatient registry, ORBIT‐AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation; 2010–2011), to evaluate event characteristics and OAC management following the first bleeding event occurring during follow‐up. Bleeding events were classified into 3 categories: (1) International Society of Thrombosis and Hemostasis major bleeding, (2) clinically relevant nonmajor bleeding requiring medical attention, and (3) nuisance bleeding not requiring medical attention (eg, bruising, hemorrhoidal bleeding). Of 9743 patients enrolled in ORBIT‐AF with follow‐up data, 510 (3.23/100 subject‐years) experienced a major bleed, 615 (3.90/100 subject‐years), experienced a clinically relevant nonmajor bleed, and 1558 (9.87/100 subject‐years) experienced a nuisance bleed, among first bleeds over 2 years. Nearly one third of patients (31.6%) discontinued OAC therapy following a major bleeding event, 12.7% following a clinically relevant nonmajor bleed, and 4.5% following a nuisance bleed. Compared with those who experienced a clinically relevant nonmajor or nuisance bleed, patients who experienced a major bleed were more likely to be black and female and to have a history of heart failure and stroke. Those who discontinued were more likely to have central nervous system or gastrointestinal bleeding than those who persisted on OAC therapy. Conclusions Overall, 1 in 3 patients who experienced a major bleed was no longer anticoagulated after the event. Those who discontinued OAC were more likely to have central nervous system or gastrointestinal bleeding than those who persisted on OAC.

Published
2018
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4. Contributors

Author

Ivy Altomare, Jack E. Ansell, Donald M. Arnold, Kenneth I. Ataga, Yu Bai, Bethany T. Samuelson Bannow, Shannon M. Bates, Kenneth A. Bauer, Jeffrey Berger, Robert A. Brodsky, Junmei Chen, Dominic W. Chung, Gregory C. Connolly, Laura S. Connelly-Smith, Mark A. Crowther, Brett Cucchiara, Julia M. Cunningham, Meghan Delaney, Thomas G. DeLoughery, Jorge Di Paola, Miguel A. Escobar, Christopher G. Favilla, Jason Freed, Jean-Philippe Galanaud, David A. Garcia, Eleni Gavriilaki, John R. Hess, John B. Holcomb, Andra H. James, Shawn M. Jobe, Susan R. Kahn, Raj S. Kasthuri, Craig M. Kessler, Alok A. Khorana, Craig S. Kitchens, Harvey G. Klein, Barbara A. Konkle, Rebecca Kruse-Jarres, Monisha Kumar, David J. Kuter, Thomas Langerak, Janice W. Lawson, Cindy A. Leissinger, Marcel Levi, Ton Lisman, José A. López, Richard Lottenberg, Molly W. Mandernach, Steven R. Messé, Siraj Mithoowani, Joel L. Moake, Stephan Moll, Martina C. Murphy, Mariasanta Napolitano, H. Tahsin Özpolat, Thomas L. Ortel, Kristy Pahl, Robert J. Porte, Leslie Raffini, Anita Rajasekhar, Nazir Savji, Suman L. Sood, Michael B. Streiff, Hugo ten Cate, Eric C.M. Van Gorp, Theodore E. Warkentin, Ewa Wysokinska, Ann B. Zimrin, and Marc Zumberg

Published
2019

5. Abstract 17225: Therapeutic Strategies Following Major Bleeding in Atrial Fibrillation: Findings From ORBIT-AF

Author

Emily C O'Brien, DaJuanicia N Simon, Gregg C Fonarow, Jack E Ansell, Peter R Kowey, Bernard J Gersh, Kenneth Mahaffey, Eric D Peterson, Jonathan P Piccini, and Elaine M Hylek

Subjects
Physiology (medical), Cardiology and Cardiovascular Medicine
Abstract

Background: Little information exists on clinical characteristics and treatment patterns of patients with atrial fibrillation (AF) following a major bleeding event in clinical practice. Methods: We used data from a large, national outpatient registry, ORBIT-AF (2010 – 2011), to evaluate event characteristics and oral anticoagulation (OAC) management following a major bleeding event. Major bleeds were defined according to ISTH criteria. We compared baseline characteristics among patients who persisted on OAC therapy at the first clinic visit following a major bleed and those in whom OAC was discontinued using chi-squared tests. Results: Of 10135 patients enrolled in ORBIT-AF, n=791 (7.8%) bleeding events occurred during 2 years of follow-up. Among patients who were receiving OA, n=632 (3.5 per 100 person years) experienced a major bleed. Of these, 67.3% experienced a fall in hemoglobin and 46.8% required transfusion of 2 of more units of red blood cells. Critical site bleeding occurred in 150 OAC patients, with the majority of these classified as intracranial bleeding (n= 89), followed by retroperitoneal (n=25) and intraocular (n=17). Fatal bleeds occurred in 37 patients (5.9% of all major bleeds). Nearly one-third of patients (31.0%) discontinued OAC therapy following the major bleeding event. Compared with those who persisted on OAC, patients who discontinued OAC were more likely to have hypertension and CKD. Those who discontinued OAC were more likely to have gastrointestinal or CNS site bleeding compared with those who persisted (Table). Conclusions: One in three patients who experienced a major bleed were no longer optimally anticoagulated after the event. Those who discontinued OAC had a greater comorbidity burden and more likely to have bleeding in a critical site those who persisted on OAC.

Published
2015

6. Outpatient Anticoagulant Therapy

Author

Jack E. Ansell

Subjects
medicine.medical_specialty, Anticoagulant therapy, business.industry, Internal medicine, Medicine, Intensive care medicine, business
Published
2013

7. Contributors

Author

William C. Aird, Jack E. Ansell, Kenneth I. Ataga, Yu Bai, Shannon M. Bates, Richard C. Becker, Peter C. Block, Charles D. Bolan, Junmei Chen, Dominic W. Chung, Gregory C. Connolly, Mark Crowther, Brett Cucchiara, Meghan Delaney, Thomas G. DeLoughery, Jorge Di Paola, Miguel A. Escobar, Patrick F. Fogarty, Jean-Philippe Galanaud, James N. George, Samuel Z. Goldhaber, David Green, John A. Heit, John R. Hess, John B. Holcomb, Andra H. James, Shawn Jobe, Eefje Jong, Craig M. Kessler, Susan R. Khan, Alok A. Khorana, Craig S. Kitchens, Harvey G. Klein, Barbara A. Konkle, Jamie Koprivnikar, Rebecca Kruse-Jarres, Monisha Kumar, Nicholas R. Kunio, David J. Kuter, Janice W. Lawson, Cindy A. Leissinger, Marcel Levi, Michael Linenberger, Ton Lisman, Jose A. Lopez, Richard Lottenberg, Tieraona Low Dog, B. Gail Macik, Molly W. Mandernach, Victor J. Marder, Merry-Jennifer Markham, Joel L. Moake, Stephan Moll, Travis Morrison-McKell, Thomas L. Ortel, Christopher Patriquin, Robert J. Porte, Leslie Raffini, Anita Rajasakhar, Jacob H. Rand, Margaret E. Rick, Harold R. Roberts, Lewis J. Rubin, Martin A. Schreiber, Suman Sood, Michael B. Streiff, Bundarika Suwanawiboon, Hugo ten Cate, Eric C.M. Van, Sreekanth Vemulapalli, Theodore E. Warkentin, Lucia R. Wolgast, Ann B. Zimrin, and Marc Zumberg

Published
2013

8. Simultaneous chronic lymphocytic leukemia and chronic myelogenous leukemia. Evidence of a separate stem cell origin

Author

V. Ellen Maher, Jack E. Ansell, Bruce A. Woda, Lisa Gill, E B S Janice Wallace, Philip L. Townes, and B S Louis Savas

Subjects
Cancer Research, Myeloid, Chronic lymphocytic leukemia, Cell of origin, breakpoint cluster region, Biology, medicine.disease, Philadelphia chromosome, medicine.anatomical_structure, Oncology, hemic and lymphatic diseases, Immunology, medicine, Stem cell, Progenitor cell, Chronic myelogenous leukemia
Abstract

The authors studied a patient with the simultaneous occurrence of chronic lymphocytic leukemia (CLL) and chronic myelogenous leukemia (CML). The coexistence of these two hematologic malignancies leads to questions about their cell of origin. Through analysis of this patient's DNA, the authors studied the derivation of the two malignancies. They separated the blood into a myeloid-rich fraction and a fraction containing the malignant lymphocytes. JH and bcr probes were used to study these loci in the myeloid and lymphoid fractions and in unfractionated white blood cells. The authors found that the unfractionated leukocytes contained the bcr and JH rearrangements. Conversely, the lymphoid fraction contained only the JH rearrangement, and the myeloid fraction contained only the bcr rearrangement, suggesting that these malignancies arose from separate stem cells. This is the first reported patient with simultaneously occurring CML and CLL definitively shown to arise from distinct progenitors, and this report raises questions about the origin of these two cell lines.

Published
1993

11. Contributors

Author

Victoria Afshani, William C. Aird, Barbara M. Alving, Jack E. Ansell, Kenneth Ataga, Richard C. Becker, Peter C. Block, Lisa N. Boggio, Charles D. Bolan, Andrew K. Burroughs, Hugo ten Cate, Richard Chang, Mary Cushman, Thomas G. DeLoughery, Jorge Di Paola, Tieraona Low Dog, Miguel A. Escobar, Bruce M. Ewenstein, Andres Fernandez, Charles W. Francis, James N. George, David L. Gillespie, Samuel Z. Goldhaber, David Green, Christine L. Hann, John A. Heit, John R. Hess, William R. Hiatt, Christopher D. Hillyer, John B. Holcomb, McDonald K. Horne, Mark R. Jackson, Shawn Jobe, Eefje Jong, Craig M. Kessler, Nushmia Khokhar, Craig S. Kitchens, Harvey G. Klein, Kiarash Kojouri, Barbara A. Konkle, Kendra Kubiak, Jody L. Kujovich, David J. Kuter, Carrie LaBelle, Marcel Levi, Miles B. Levin, Mark Levine, Minetta Liu, Richard Lottenberg, B. Gail Macik, Victor J. Marder, Merry Jennifer Markham, Stephan A. Mayer, Jan Jacques Michiels, Joel L. Moake, Thomas L. Ortel, Reagan W. Quan, Jacob H. Rand, Margaret E. Rick, Frederick R. Rickles, Fred Rincon, Harold R. Roberts, Lewis J. Rubin, Marco Senzolo, Stephanie Seremetis, Chelsea A. Sheppard, Suman Sood, Steven Stein, Michael B. Streiff, Bundarika Suwanawiboon, Eric C.M. van Gorp, Theodore E. Warkentin, Ann B. Zimrin, and Marc Zumberg

Published
2007

12. CONTRIBUTORS

Author

Amjad AlMahameed, Jack E. Ansell, Melinda Aquino, John Aruny, Juan Ayerdi, Joshua A. Beckman, Jill J.F. Belch, Michael Belkin, Bradford C. Berk, Francine Blei, Peter Blume, Eric P. Brass, Allen P. Burke, Louis R. Caplan, Maria C. Cid, Jay D. Coffman, John P. Cooke, Mark A. Creager, Michael H. Criqui, Jack L. Cronenwett, Mark D.P. Davis, Gregory J. del Zoppo, Magruder C. Donaldson, Matthew J. Eagleton, Matthew S. Edwards, Jonathan E.E. Fisher, Thomas G. Flohr, Jane E. Freedman, Julie A. Freischlag, David R. Fulton, Marie Gerhard-Herman, Mary E. Giswold, Samuel Z. Goldhaber, Irwin Goldstein, Heather L. Gornik, Christopher H. Gram, Edwin C. Gravereaux, Jonathan L. Halperin, Kimberley J. Hansen, George Hanzel, William R. Hiatt, Robert W. Hobson, Gary S. Hoffman, Sriram S. Iyer, Laura B. Kane, Andrew Kang, William B. Kannel, Tara Karamlou, Noel N. Kim, Elizabeth S. Klings, Itzhak Kronzon, Nils Kucher, Everett Y. Lam, Gregory J. Landry, Scott A. LeMaire, Lilach O. Lerman, Peter Libby, Martin J. Lipton, Joseph Loscalzo, Herbert I. Machleder, Kathleen Maksimowicz-McKinnon, Jess Mandel, Matthew T. Menard, James O. Menzoian, Peter A. Merkel, Virginia M. Miller, Gregory L. Moneta, Ricardo Munarriz, Jane W. Newburger, John Ninomiya, Patrick O'Gara, Jeffrey W. Olin, Stephen T. O'Rourke, Kenneth Ouriel, Jacek Paszkowiak, Dean Patterson, Joseph D. Raffetto, Rajendra Raghow, David A. Rigberg, Stanley G. Rockson, Thom W. Rooke, Gary S. Roubin, Frederick L. Ruberg, Eva M. Rzucidlo, Robert D. Safian, U. Joseph Schoepf, Jerome Seyer, Piotr Sobieszczyk, Sunita D. Srivastava, Michael Stanton-Hicks, Bauer E. Sumpio, Allen J. Taylor, Lloyd M. Taylor, Stephen C. Textor, Robert W. Thompson, James N. Topper, Abdul M. Traish, Paul A. Tunick, Gilbert R. Upchurch, R. James Valentine, Paul M. Vanhoutte, Renu Virmani, Jiri J. Vitek, Scott M. Wasserman, Giora Weisz, M. Burress Welborn, Christopher J. White, David B. Wilson, Philip A. Wolf, and E. Kent Yucel

Published
2006

13. Venous Thrombosis

Author

Jack E. Ansell

Subjects
medicine.medical_specialty, Venous thrombosis, business.industry, Internal medicine, medicine, Cardiology, medicine.disease, business
Published
2006

15. Anticoagulation, Acute and Chronic: Indications and Methods

Author

Jack E. Ansell

Subjects
medicine.medical_specialty, medicine.diagnostic_test, medicine.drug_class, business.industry, Warfarin therapy, Warfarin, Low molecular weight heparin, Heparin, Nomogram, Therapeutic index, medicine, Dosing, Intensive care medicine, business, medicine.drug, Partial thromboplastin time
Abstract

Failure to rapidly achieve a therapeutic level of heparin therapy is remedied by the use of heparin-dosing nomograms. The activated partial thromboplastin time is highly inaccurate unless ex vivo heparin titration curves are used to establish a reagent-specific therapeutic range. The advantages of low molecular weight heparin (LMWH) over unfractionated heparin relate to its subcutaneous use, the ability to perform daily dosing once or twice, and the absence of the need for monitoring. Studies now document the equivalency or even superiority of LMWH over unfractionated heparin for the treatment of acute deep venous thrombosis. Home therapy is also a promising mode of treatment. Warfarin therapy is associated with the fewest complications when managemenet is performed by a coordinated system of oversight referred to as anticoagulation management service. Future models of warfarin management include patient self-testing and patient self-management.

Published
2001

16. Preface

Author

Jack E. Ansell

Subjects
Hematology, Cardiology and Cardiovascular Medicine
Published
2006

17. Preface

Author

Jack E. Ansell

Subjects
Hematology, Cardiology and Cardiovascular Medicine
Published
2003

19. Gelfoam and autologous clot embolization: effect on coagulation

Author

Willard C. Johnson, Daniel Deykin, Warren C. Widrich, Donald C. Nabseth, Jack E. Ansell, Alan H. Robbins, and Max Maizels

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Thrombin time, Fibrinogen, Esophageal and Gastric Varices, Fibrin, medicine, Humans, Radiology, Nuclear Medicine and imaging, Embolization, Disseminated intravascular coagulation, Prothrombin time, biology, medicine.diagnostic_test, business.industry, General Medicine, Disseminated Intravascular Coagulation, Middle Aged, medicine.disease, Embolization, Therapeutic, Gelatin Sponge, Absorbable, Surgery, Coagulation, biology.protein, business, Gastrointestinal Hemorrhage, circulatory and respiratory physiology, medicine.drug, Partial thromboplastin time
Abstract

An episode of disseminated intravascular coagulation following therapeutic gelfoam embolization to control bleeding from esophageal varices in a patient with liver disease is presented. We have since followed 13 patients prospectively (six control and seven gelfoam/autologous clot) to determine the effect of this procedure on clotting. We were unable to show significant differences between the two groups as measured by the prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen and platelet count. However, fibrin (ogen) degradation products were significantly elevated (p less than .01) in the gelfoam/autologous clot group. We suspect this occurred secondary to clot lysis at the site of embolization. No subsequent bleeding diathesis attributable to this abnormality occurred in any of the patients.

Published
1978

20. Control of bleeding varices by vasopressin: a prospective randomized study

Author

Warren C. Widrich, Alan H. Robbins, Jack E. Ansell, Donald C. Nabseth, and Willard C. Johnson

Subjects
Vasopressin, medicine.medical_specialty, Randomization, Vasopressins, Stomach Diseases, Esophageal and Gastric Varices, Catheterization, Varicose Veins, Route of administration, medicine.artery, medicine, Humans, Superior mesenteric artery, Prospective Studies, Vein, medicine.diagnostic_test, business.industry, SMA, Surgery, Endoscopy, Mesenteric Arteries, Vasomotor System, medicine.anatomical_structure, Varices, business, Gastrointestinal Hemorrhage, Research Article
Abstract

From July 1975 to November 1976 25 patients with bleeding esophagogastric varices documented by endoscopy who failed to respond to conservative medical treatment were transferred to the Surgical Service. These patients, who were mainly Child's Class "C" alcoholic cirrhotic patients, were treated with vasopressin infused continuously using a standardized dose into either a peripheral vein or the superior mesenteric artery (SMA) according to a predetermined randomization. No significant difference in efficacy for control of bleeding (average rate = 56%) related to route of administration was found. Because catheter-related complications in the SMA group were significantly greater, we concluded that the method of choice in vasopressin treatment of esophagogastric variceal bleeding is a continuous infusion by way of a peripheral vein.

Published
1977

21. Clinical trial of a new bleeding-time device

Author

Rosa T. Canoso, Jack E. Ansell, Raminder Kumar, and Daniel Deykin

Subjects
Male, Aspirin, medicine.medical_specialty, Clinical Trials as Topic, medicine.diagnostic_test, business.industry, General Medicine, Surgery, Clinical trial, Bleeding time procedure, Bleeding time, Evaluation Studies as Topic, Reference Values, Reference values, Healthy volunteers, medicine, Ingestion, Humans, New device, Female, Blood Coagulation Tests, business, medicine.drug
Abstract

The authors report a clinical trial comparing a new bleeding time device (Simplate II) with the Mielke Template. Bleeding times were determined at the same time on the same arm using the two devices. Subjects of the study were 24 healthy volunteers, before and two hours after ingestion of 975 mg aspirin, and 28 patients. For the normal subjects the mean pre-aspirin bleeding times were 4.75 +/- 1.42 minutes (1 SD) with the Simplate II and 3.65 +/- 1.22 minutes with the Mielke Template. The mean bleeding times two hours after ingestion of aspirin were 7.86 +/- 2.76 minutes with the Simplate II and 7.84 +/- 2.94 minutes with the Template. The pre- and the post-aspirin values with the two devices were not significantly different from each other, nor were the bleeding times obtained in the patients with the two devices. The extents of scarring were similar with the two devices. The results were highly reproducible by both methods. The new device was simpler and more rapid to use.

Published
1978

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