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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Interpretation and management of INR results: A case history based survey in 13 countries
Thrombosis Research, Volume 130, No. 3, Year 2012
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Description
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. © 2012 Elsevier Ltd.
Authors & Co-Authors
Kristoffersen, Ann Helen
Norway, Bergen
Haukeland Universitetssjukehus
Thue, Geir
Norway, Bergen
Universitetet I Bergen
Ajzner, Eva
Hungary, Nyiregyhaza
Jósa András Teaching Hospital
Claes, Neree
Belgium, Hasselt
Universiteit Hasselt
Horvàth, Rita
Australia, Sydney
The University of Sydney
Australia, Sydney
The University of Sydney School of Public Health
Leonetti, Rina
Australia, Sydney
The University of Sydney
Kallion, Kaja
Estonia, Tartu
Tartu Ülikooli Kliinikum
Kitchen, Dianne
United Kingdom, Sheffield
Uk Neqas Blood Coagulation
Kitchen, Steven
United Kingdom, Sheffield
Uk Neqas Blood Coagulation
Kutt, Marge
Estonia, Tallinn
East Tallinn Central Hospital
Meijer, Piet
Netherlands, Leiden
Ecat Foundation
Müller, Matthias M.
Austria, Vienna
Austrian Society of Quality Assurance and Standardisation
Nilsson, Elisabeth
Sweden, Uppsala
Equalis ab
Perich, Carmen
Spain, Barcelona
Sociedad Española de Bioquimica Clinica y Patologia Molecular
Plum, Inger Graves
Denmark, Hellerup
Gentofte Hospital
Rogic, Dunja
Croatia, Zagreb
Kbc Zagreb
Tirimacco, Rosy
South Africa, Bedford
Country Health sa
Van Der Meer, Felix J.M.
Netherlands, Leiden
Leids Universitair Medisch Centrum
Watine, Joseph
France, Dijon
Centre Hospitalier la Chartreuse
Sandberg, Sverre
Norway, Bergen
Haukeland Universitetssjukehus
Norway, Bergen
Universitetet I Bergen
Statistics
Citations: 20
Authors: 20
Affiliations: 18
Identifiers
Doi:
10.1016/j.thromres.2012.02.014
ISSN:
00493848
e-ISSN:
18792472
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Cross Sectional Study
Study Approach
Quantitative