nach oben

Journal of Thrombosis and Thrombolysis

Erschienen in:

01.04.2015

Engaging with quality improvement in anticoagulation management

verfasst von: Geoffrey D. Barnes, Eva Kline-Rogers

Erschienen in: Journal of Thrombosis and Thrombolysis | Ausgabe 3/2015

Einloggen, um Zugang zu erhalten

Abstract

Anticoagulants are highly effective at preventing thrombosis across a variety of clinical indications. However, their use can also lead to devastating effects, including major bleeding and death. Anticoagulation providers strive to balance the benefits of anticoagulant therapy with the risks of major bleeding. A measure of quality care can be used to assess the strengths and potential weaknesses in any system of coordinated care delivery. Quality measures in anticoagulation include patient-centered outcomes (e.g. major bleeding, time in the therapeutic range) and provider- or process-focused outcomes (e.g. compliance with guideline recommendations and response times to out-of-range laboratory values). Engaging in quality improvement activities allows anticoagulation providers to assess their own performance and identify areas for targeted interventions. This review summarizes the justification for engaging in quality improvement for anticoagulation management and describes a number of example programs. Interventions benefiting the management of both warfarin and the direct oral anticoagulants are included. The review also details potential quality measures and resources for any anticoagulation provider looking to begin a quality improvement process.

Kirley K, Qato DM, Kornfield R, Stafford RS, Alexander GC (2012) National trends in oral anticoagulant use in the United States, 2007 to 2011. Circ Cardiovasc Qual Outcomes 5:615–621CrossRefPubMedCentralPubMed

Singer DE, Chang Y, Fang MC et al (2009) Should patient characteristics influence target anticoagulation intensity for stroke prevention in nonvalvular atrial fibrillation? The ATRIA study. Circ Cardiovasc Qual Outcomes 2:297–304CrossRefPubMedCentralPubMed

Dlott JS, George RA, Huang X et al (2014) National assessment of warfarin anticoagulation therapy for stroke prevention in atrial fibrillation. Circulation 129:1407–1414CrossRefPubMed

Cancino RS, Hylek EM, Reisman JI, Rose AJ (2014) Comparing patient-level and site-level anticoagulation control as predictors of adverse events. Thromb Res 133:652–656CrossRefPubMed

Rose AJ, Berlowitz DR, Ash AS, Ozonoff A, Hylek EM, Goldhaber-Fiebert JD (2011) The business case for quality improvement: oral anticoagulation for atrial fibrillation. Circ Cardiovasc Qual Outcomes 4:416–424CrossRefPubMedCentralPubMed

Ibrahim S, Jespersen J, Poller L, European Action on A (2013) The clinical evaluation of International Normalized Ratio variability and control in conventional oral anticoagulant administration by use of the variance growth rate. J Thromb Haemost 11:1540–1546CrossRefPubMed

Lind M, Fahlen M, Kosiborod M, Eliasson B, Oden A (2012) Variability of INR and its relationship with mortality, stroke, bleeding and hospitalisations in patients with atrial fibrillation. Thromb Res 129:32–35CrossRefPubMed

Wallentin L, Yusuf S, Ezekowitz MD et al (2010) Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial. Lancet 376:975–983CrossRefPubMed

Kachroo S, Boyd D, Bookhart BK et al (2012) Quality of life and economic costs associated with postthrombotic syndrome. Am J Health Syst Pharm 69:567–572CrossRefPubMed

10.

Chitsike RS, Rodger MA, Kovacs MJ et al (2012) Risk of post-thrombotic syndrome after subtherapeutic warfarin anticoagulation for a first unprovoked deep vein thrombosis: results from the REVERSE study. J Thromb Haemost 10:2039–2044CrossRefPubMed

11.

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (2014) National Action Plan for Adverse Drug Event Prevention. U.S. Department of Health and Human Services, Washington

12.

Healthcare Facilities Accreditation Program. National Quality Forum’s 34 Safe Practices and the HFAP Related Standards. 2013. Chicago, IL. Available at http://www.hfap.org/pdf/patient_safety.pdf

13.

Witt DM (2011) Quality measures and benchmarking for warfarin therapy. J Thromb Thrombolysis 31:242–248CrossRefPubMed

14.

Rose AJ, Berlowitz DR, Frayne SM, Hylek EM (2009) Measuring quality of oral anticoagulation care: extending quality measurement to a new field. Jt Comm J Qual Patient Saf 35:146–155PubMed

15.

Witt DM, Delate T, Clark NP et al (2013) Nonadherence with INR monitoring and anticoagulant complications. Thromb Res 132:e124–e130CrossRefPubMed

16.

Barnes GD, Kaatz S, Winfield J et al (2014) Warfarin use in atrial fibrillation patients at low risk for stroke: analysis of the Michigan Anticoagulation Quality Improvement Initiative (MAQI(2)). J Thromb Thrombolysis 37:171–176CrossRefPubMed

17.

Kearon C, Akl EA, Comerota AJ et al (2012) Antithrombotic therapy for VTE disease: antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141:e419S–e494SCrossRefPubMedCentralPubMed

18.

Snow V, Qaseem A, Barry P et al (2007) Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med 146:204–210CrossRefPubMed

19.

Jaff MR, McMurtry MS, Archer SL et al (2011) Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 123:1788–1830CrossRefPubMed

20.

Kearon C, Gent M, Hirsh J et al (1999) A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med 340:901–907CrossRefPubMed

21.

Schulman S, Rhedin AS, Lindmarker P et al (1995) A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. Duration of Anticoagulation Trial Study Group. N Engl J Med 332:1661–1665CrossRefPubMed

22.

Rodger MA, Kahn SR, Wells PS et al (2008) Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy. CMAJ 179:417–426CrossRefPubMedCentralPubMed

23.

Iorio A, Kearon C, Filippucci E et al (2010) Risk of recurrence after a first episode of symptomatic venous thromboembolism provoked by a transient risk factor: a systematic review. Arch Intern Med 170:1710–1716PubMed

24.

Baglin T, Luddington R, Brown K, Baglin C (2003) Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. Lancet 362:523–526CrossRefPubMed

25.

Holbrook A, Schulman S, Witt DM et al (2012) Evidence-based management of anticoagulant therapy: antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141:e152S–e184SCrossRefPubMedCentralPubMed

26.

Schulman S, Parpia S, Stewart C, Rudd-Scott L, Julian JA, Levine M (2011) Warfarin dose assessment every 4 weeks versus every 12 weeks in patients with stable international normalized ratios: a randomized trial. Ann Intern Med 155(653–659):W201–W653

27.

Puroll E, Heidt ST, Haymart B, Froehlich JB, Kline-Rogers E, Barnes GD (2014) AREDS Formula, Warfarin, and Bleeding: a Case Report from the Michigan Anticoagulation Quality Improvement Initiative. Case Rep Med 2014:754147PubMedCentralPubMed

28.

Apostolakis S, Sullivan RM, Olshansky B, Lip GY (2013) Factors affecting quality of anticoagulation control among patients with atrial fibrillation on warfarin: the SAMe-TT2R2 score. Chest 144:1555–1563CrossRefPubMed

29.

Razouki Z, Ozonoff A, Zhao S, Jasuja GK, Rose AJ (2014) Improving quality measurement for anticoagulation: adding international normalized ratio variability to percent time in therapeutic range. Circ Cardiovasc Qual Outcomes. 7:664–669CrossRefPubMed

30.

Bhatt DL, Scheiman J, Abraham NS et al (2008) ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation 118:1894–1909CrossRefPubMed

31.

Dewilde WJ, Oirbans T, Verheugt FW et al (2013) Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet 381:1107–1115CrossRefPubMed

32.

Lamberts M, Gislason GH, Lip GY et al (2014) Antiplatelet therapy for stable coronary artery disease in atrial fibrillation patients taking an oral anticoagulant: a nationwide cohort study. Circulation 129:1577–1585CrossRefPubMed

33.

Dewilde WJ, Janssen PW, Verheugt FW et al (2014) Triple therapy for atrial fibrillation and percutaneous coronary intervention: a contemporary review. J Am Coll Cardiol 64:1270–1280CrossRefPubMed

34.

Lindh JD, Andersson ML, Mannheimer B (2014) Adherence to guidelines for avoiding drug interactions associated with warfarin–a Nationwide Swedish Register Study. PLoS One 9:e97388CrossRefPubMedCentralPubMed

35.

Guthrie B, McCowan C, Davey P, Simpson CR, Dreischulte T, Barnett K (2011) High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice. BMJ 342:d3514CrossRefPubMed

36.

Camm AJ, Kirchhof P, Lip GY et al (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31:2369–2429CrossRefPubMed

37.

Desai NR, Krumme AA, Schneeweiss S et al (2014) Patterns of initiation of oral anticoagulants in patients with atrial fibrillation- quality and cost implications. Am J Med 127(1075–1082):e1071

38.

Xu Y, Holbrook AM, Simpson CS, Dowlatshahi D, Johnson AP (2013) Prescribing patterns of novel oral anticoagulants following regulatory approval for atrial fibrillation in Ontario, Canada: a population-based descriptive analysis. CMAJ open 1:E115–E119CrossRefPubMedCentralPubMed

39.

Steinberg BA, Holmes DN, Piccini JP et al (2013) Early adoption of dabigatran and its dosing in US patients with atrial fibrillation: results from the outcomes registry for better informed treatment of atrial fibrillation. J Am Heart Assoc 2:e000535CrossRefPubMedCentralPubMed

40.

Sorensen R, Gislason G, Torp-Pedersen C et al (2013) Dabigatran use in Danish atrial fibrillation patients in 2011: a nationwide study. BMJ Open 3:e002758CrossRefPubMedCentralPubMed

41.

Harper P, Young L, Merriman E (2012) Bleeding risk with dabigatran in the frail elderly. N Engl J Med 366:864–866CrossRefPubMed

42.

Larock AS, Mullier F, Sennesael AL et al (2014) Appropriateness of prescribing dabigatran etexilate and rivaroxaban in patients with nonvalvular atrial fibrillation: a prospective study. Ann Pharmacother 48:1258–1268CrossRefPubMed

43.

Heidbuchel H, Verhamme P, Alings M et al (2013) EHRA practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary. Eur Heart J 34:2094–2106CrossRefPubMed

Titel: Engaging with quality improvement in anticoagulation management
verfasst von: Geoffrey D. Barnes
Eva Kline-Rogers
Publikationsdatum: 01.04.2015
Verlag: Springer US
Erschienen in: Journal of Thrombosis and Thrombolysis / Ausgabe 3/2015
Print ISSN: 0929-5305
Elektronische ISSN: 1573-742X
DOI: https://doi.org/10.1007/s11239-015-1184-8

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

„Jeder Fall von plötzlichem Tod muss obduziert werden!“

17.05.2024 Plötzlicher Herztod Nachrichten

Ein signifikanter Anteil der Fälle von plötzlichem Herztod ist genetisch bedingt. Um ihre Verwandten vor diesem Schicksal zu bewahren, sollten jüngere Personen, die plötzlich unerwartet versterben, ausnahmslos einer Autopsie unterzogen werden.

Hirnblutung unter DOAK und VKA ähnlich bedrohlich

17.05.2024 Direkte orale Antikoagulanzien Nachrichten

Kommt es zu einer nichttraumatischen Hirnblutung, spielt es keine große Rolle, ob die Betroffenen zuvor direkt wirksame orale Antikoagulanzien oder Marcumar bekommen haben: Die Prognose ist ähnlich schlecht.

Schlechtere Vorhofflimmern-Prognose bei kleinem linken Ventrikel

17.05.2024 Vorhofflimmern Nachrichten

Nicht nur ein vergrößerter, sondern auch ein kleiner linker Ventrikel ist bei Vorhofflimmern mit einer erhöhten Komplikationsrate assoziiert. Der Zusammenhang besteht nach Daten aus China unabhängig von anderen Risikofaktoren.

Semaglutid bei Herzinsuffizienz: Wie erklärt sich die Wirksamkeit?

17.05.2024 Herzinsuffizienz Nachrichten

Bei adipösen Patienten mit Herzinsuffizienz des HFpEF-Phänotyps ist Semaglutid von symptomatischem Nutzen. Resultiert dieser Benefit allein aus der Gewichtsreduktion oder auch aus spezifischen Effekten auf die Herzinsuffizienz-Pathogenese? Eine neue Analyse gibt Aufschluss.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2015

Laboratory measurement of the anticoagulant activity of edoxaban: a systematic review

Management of anticoagulation and antiplatelet therapy in patients with left ventricular assist devices

Predicting the risk of recurrent venous thromboembolism (VTE)

Proceedings of the 13th National Conference on Anticoagulant Therapy