Nicholas W Carris1,2, Alisa Spinelli3, Danielle Pierini2, James R Taylor2, Katherine Vogel Anderson2,4, Karen Sando1,2, Jason Powell2, Eric I Rosenberg2,4, Marc S Zumberg5, Steven M Smith1,2, John G Gums1,2, Eric Dietrich1,2. 1. Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA. 2. Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA. 3. Department of Pharmacy Practice, Belmont University College of Pharmacy, Nashville, TN, USA. 4. Division of Internal Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA. 5. Division of Hematology/Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
Abstract
AIMS: The 2012 American College of Chest Physician Evidence-Based Management of Anticoagulant Therapy guidelines suggest an international normalized ratio (INR) testing interval of up to 12 weeks, rather than every 4 weeks, for patients with consistently stable INRs while taking vitamin K antagonists. We aimed to examine the feasibility of extended-interval follow-up in a real-world setting. METHODS: Patients receiving stable warfarin therapy for ≥ 12 weeks at baseline began extended-interval follow-up with visits occurring at 6 weeks, 14 weeks, and every 12 weeks thereafter to a maximum of 68 weeks or until they were no longer suitable for extended-interval follow-up. A single INR excursion >0.3 from goal was permitted if a reversible precipitating factor was identified and the INR was expected to return to goal without dose adjustment. The primary outcome was the proportion of patients completing all study follow-up visits. RESULTS: Of 48 patients enrolled, 47 had evaluable data. The most common indication for anticoagulation was atrial fibrillation/flutter (53.2%). At baseline, mean prior warfarin treatment duration was 6.7 ± 6 years and median number of weeks on a stable regimen was 24 weeks (IQR, 19-37.5). Eleven patients (23%) completed all study follow-up visits, whereas 17 (36%) did not maintain a stable INR past the 14-week follow-up. CONCLUSION: A large proportion of patients with previously stable (≥ 3 months) INRs were not able to maintain stable INRs during extended-interval follow-up. More research is needed to identify patient characteristics predictive of success with extended-interval follow-up prior to broad implementation.
AIMS: The 2012 American College of Chest Physician Evidence-Based Management of Anticoagulant Therapy guidelines suggest an international normalized ratio (INR) testing interval of up to 12 weeks, rather than every 4 weeks, for patients with consistently stable INRs while taking vitamin K antagonists. We aimed to examine the feasibility of extended-interval follow-up in a real-world setting. METHODS:Patients receiving stable warfarin therapy for ≥ 12 weeks at baseline began extended-interval follow-up with visits occurring at 6 weeks, 14 weeks, and every 12 weeks thereafter to a maximum of 68 weeks or until they were no longer suitable for extended-interval follow-up. A single INR excursion >0.3 from goal was permitted if a reversible precipitating factor was identified and the INR was expected to return to goal without dose adjustment. The primary outcome was the proportion of patients completing all study follow-up visits. RESULTS: Of 48 patients enrolled, 47 had evaluable data. The most common indication for anticoagulation was atrial fibrillation/flutter (53.2%). At baseline, mean prior warfarin treatment duration was 6.7 ± 6 years and median number of weeks on a stable regimen was 24 weeks (IQR, 19-37.5). Eleven patients (23%) completed all study follow-up visits, whereas 17 (36%) did not maintain a stable INR past the 14-week follow-up. CONCLUSION: A large proportion of patients with previously stable (≥ 3 months) INRs were not able to maintain stable INRs during extended-interval follow-up. More research is needed to identify patient characteristics predictive of success with extended-interval follow-up prior to broad implementation.
Authors: Andrea L Porter; Amanda R Margolis; Rebecca R Schoen; Carla E Staresinic; Cheryl A Ray; Christopher D Fletcher Journal: J Thromb Thrombolysis Date: 2017-04 Impact factor: 2.300
Authors: Nicholas W Carris; Andrew Y Hwang; Steven M Smith; James R Taylor; Karen Sando; Jason Powell; Eric I Rosenberg; Marc S Zumberg; John G Gums; Eric A Dietrich; Katherine Vogel Anderson Journal: J Thromb Thrombolysis Date: 2016-11 Impact factor: 2.300
Authors: Andrea L Porter; Amanda R Margolis; Carla E Staresinic; Michael W Nagy; Rebecca R Schoen; Cheryl A Ray; Christopher D Fletcher Journal: J Thromb Thrombolysis Date: 2019-02 Impact factor: 2.300
Authors: Geoffrey D Barnes; Sevan Misirliyan; Scott Kaatz; Elizabeth A Jackson; Brian Haymart; Eva Kline-Rogers; Jay Kozlowski; Gregory Krol; James B Froehlich; Anne Sales Journal: Implement Sci Date: 2017-07-14 Impact factor: 7.327