Anticoagulation

Perioperative management of women on oral anticoagulants and antiplatelet agents undergoing gynaecological procedures (2020)

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Type of publication:
Journal article

Author(s):
*Goh E.; Barker V.; Lee P.L.; *Eden D.; *Davies O.; *Sahu B.

Citation:
Obstetrician and Gynaecologist; 2020; Vol 22(2) p. 131-136

Abstract:
Key content: The number of women attending gynaecological services who are taking oral anticoagulants and antiplatelet agents is increasing. Direct oral anticoagulants are becoming increasingly popular and offer an alternative to warfarin. Knowledge of the use of anticoagulants in the perioperative period is imperative to provide optimal care and ensure patient safety. It is essential that health professionals practising gynaecology, at all levels, keep up to date to reduce unnecessary cancellations, delays in treatment and risks of thrombosis and bleeding. Learning objectives: To understand the management of women on oral anticoagulant and antiplatelet agents undergoing elective and emergency gynaecological procedures. To appreciate the importance of assessing patient- and procedural-related risks of thrombosis and bleeding. To review commonly used anticoagulant and antiplatelet agents.

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Individual and monitoring centre influences upon anticoagulation control of AF patients on warfarin: a longitudinal multicentre UK-based study (2018)

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Type of publication:
Journal article

Author(s):
Abohelaika, Salah; Wynne, Hilary; Avery, Peter; Robinson, Brian; Jones, Lisa; Tait, Campbell; Dickinson, Bradley; Salisbury, Julie; Nightingale, Joanna; *Green, Louise; Kamali, Farhad

Citation:
European Journal of Haematology 2018 October, 101:486–495.

Abstract:
OBJECTIVES Time within therapeutic INR range (TTR) predicts benefits/risk of warfarin therapy. Identification of individual- and centre-related factors that influence TTR, and addressing them to improve anticoagulation control, are important. This study examined the impact of individual and centre-related factors uponlong-term anticoagulation control in atrial fibrillation patients in seven UK-based monitoring services. METHODS Data between 2000 and 2014 on 25,270 patients (equating to 203,220 patient years) [18,120 (71.7%) in general practice, 2,348 (9.3%) in hospital-based clinics and 4,802 (19.0%) in domiciliary service] were analysed. RESULTS TTR increased with increasing age, peaking around 77% at 70-75 years, and then declined, was lower in females than males, and in dependent home-monitored patients than those attending clinic (P<0.0001). TTR, number of dose changes and INR monitoring events, and the probability of TTR≤ 65%, differed across the centres (P<0.0001). CONCLUSIONS Although all the participating centres ostensively followed a standard dosing algorithm, our results indicate that variations in practice do occur between different monitoring sites. We suggest feedback on TTR for individual monitoring sites gauged against the average values reported by others would empower the individual centres to improve quality outcomes of anticoagulation therapy by identifying and adjusting contributory factors within their management system.

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