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Interpretation and management of INR results: A case history based survey in 13 countries
- Source :
- Thrombosis Research. 130:309-315
- Publication Year :
- 2012
- Publisher :
- Elsevier BV, 2012.
-
Abstract
- Introduction Standardisation of treatment with vitamin K antagonists (VKAs) is still an issue after 60 years of use. The study aimed to explore aspects of VKA monitoring in primary and secondary care. Methods Two case histories were distributed to physicians in 13 countries. Case history A focused on a patient with atrial fibrillation on stable anticoagulation (latest INR 2.3). Physicians were asked about frequency of INR measurement, when to change the VKA dose, and the patient's annual risk of ischemic stroke and bleeding. Case history B focused on a patient with an unexpected INR of 4.8, asking for the patient's 48-hour bleeding risk, the immediate dose reduction and time until a repeat INR. Results Altogether, 3016 physicians responded (response rate 8 – 38%), of which 82% were from primary care and 18% from secondary care. Answers varied substantially within and between countries regardless of level of care and VKA used. Median number of weeks between INR measurements was 4 – 6 weeks. Median threshold INR for increasing or decreasing the VKA dose was 1.9 and 3.1, respectively. Risk of ischemic stroke and bleeding were overestimated 2 – 3 times. In case history B, the median dose reduction the two first days was 75% for GPs and 55% for specialists, irrespective of estimates of bleeding risk; with one week to a repeat INR. Conclusion Variation in VKA monitoring is substantial implying clinical consequences. Guidelines seem either unknown or may be considered impracticable. Further efforts towards standardisation of VKA management are needed.
- Subjects :
- Response rate (survey)
Pediatrics
medicine.medical_specialty
Internationality
business.industry
MEDLINE
Case-control study
Anticoagulants
Thrombosis
Atrial fibrillation
Orvostudományok
Hematology
Primary care
Klinikai orvostudományok
medicine.disease
Secondary care
Case-Control Studies
Atrial Fibrillation
Humans
Medicine
Dose reduction
International Normalized Ratio
Practice Patterns, Physicians'
Level of care
business
Subjects
Details
- ISSN :
- 00493848
- Volume :
- 130
- Database :
- OpenAIRE
- Journal :
- Thrombosis Research
- Accession number :
- edsair.doi.dedup.....40c265be9f3b77b9864d429ae35dfd50