National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (3)
- Adverse Events (3)
- Alcohol Use (1)
- Ambulatory Care and Surgery (1)
- Blood Clots (2)
- (-) Blood Thinners (18)
- Brain Injury (1)
- Cardiovascular Conditions (6)
- Community-Based Practice (1)
- Comparative Effectiveness (3)
- Elderly (2)
- Electronic Health Records (EHRs) (1)
- Emergency Medical Services (EMS) (1)
- Evidence-Based Practice (3)
- Genetics (1)
- Guidelines (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (2)
- Health Information Technology (HIT) (2)
- Heart Disease and Health (7)
- Hospitalization (3)
- Injuries and Wounds (1)
- Medicare (1)
- Medication (11)
- Obesity (1)
- Patient-Centered Outcomes Research (6)
- Patient Adherence/Compliance (1)
- Patient Safety (1)
- Prevention (1)
- Racial and Ethnic Minorities (1)
- Registries (2)
- Research Methodologies (1)
- Risk (4)
- Sex Factors (1)
- Stroke (1)
- Substance Abuse (1)
- Trauma (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 18 of 18 Research Studies DisplayedFan Y, Adam TJ, McEwan R
Detecting signals of interactions between warfarin and dietary supplements in electronic health records.
This study detected signals of interactions between warfarin and seven dietary supplements, viz., alfalfa, garlic, ginger, ginkgo, ginseng, St. John's Wort, and Vitamin E by analyzing structured clinical data and unstructured clinical notes from the University of Minnesota Clinical Data Repository. There was a statistically significant association of warfarin concurrently used with supplements which can potentially increase the risk of adverse events, such as gastrointestinal bleeding.
AHRQ-funded; HS022085.
Citation: Fan Y, Adam TJ, McEwan R .
Detecting signals of interactions between warfarin and dietary supplements in electronic health records.
Stud Health Technol Inform 2017;245:370-74.
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Keywords: Adverse Drug Events (ADE), Blood Thinners, Electronic Health Records (EHRs), Medication, Health Information Technology (HIT)
Spector WD, Limcangco R, Furukawa MF
AHRQ Author: Spector WD, Limcangco R, Furukawa MF, Encinosa WE
The marginal costs of adverse drug events associated with exposures to anticoagulants and hypoglycemic agents during hospitalization.
The researchers estimated the marginal cost of care associated with anticoagulants and hypoglycemic agents for adults in 5 patient groups during their hospital stay and the total annual ADE costs for all patients exposed to these drugs during their stay. The 2013 hospital cost estimates for adverse drug events associated with anticoagulants and hypoglycemic agents were >$2.5 billion for each drug class.
AHRQ-authored.
Citation: Spector WD, Limcangco R, Furukawa MF .
The marginal costs of adverse drug events associated with exposures to anticoagulants and hypoglycemic agents during hospitalization.
Med Care 2017 Sep;55(9):856-63. doi: 10.1097/mlr.0000000000000780.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Adverse Drug Events (ADE), Blood Thinners, Hospitalization, Healthcare Costs
Newgard CD, Platts-Mills TF
Can an out-of-hospital medication history save lives for injured older adults?
In this issue of Annals, Nishijima et al present a much-needed study evaluating the use of anticoagulation and antiplatelet medications as an additional triage criterion to aid in the identification of older adults with intracranial hemorrhage. The authors believe that the new study helps fill a critical void in suggesting that a targeted medication history, formally integrated as a field triage criterion, may be useful in identifying high-risk older adults.
AHRQ-funded; HS023796.
Citation: Newgard CD, Platts-Mills TF .
Can an out-of-hospital medication history save lives for injured older adults?
Ann Emerg Med 2017 Aug;70(2):139-41. doi: 10.1016/j.annemergmed.2017.02.005.
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Keywords: Blood Thinners, Elderly, Emergency Medical Services (EMS), Injuries and Wounds, Medication
Chenoweth JA, Johnson MA, Shook L
Prevalence of intracranial hemorrhage after blunt head trauma in patients on pre-injury dabigatran.
Dabigatran etexilate was the first direct-acting oral anticoagulant approved in the United States. The researchers aimed to determine the prevalence of intracranial hemorrhage for patients on dabigatran presenting to a Level I trauma center. The intracranial hemorrhage prevalence in their study was similar to previous reports for patients on warfarin.
AHRQ-funded; HS022236.
Citation: Chenoweth JA, Johnson MA, Shook L .
Prevalence of intracranial hemorrhage after blunt head trauma in patients on pre-injury dabigatran.
West J Emerg Med 2017 Aug;18(5):794-99. doi: 10.5811/westjem.2017.5.33092.
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Keywords: Blood Thinners, Brain Injury, Trauma, Risk, Medication
Lee SY, Cherian R, Ly I
Designing and implementing an electronic patient registry to improve warfarin monitoring in the ambulatory setting.
The researchers designed and implemented an electronic registry in conjunction with a complementary work flow that established an active tracking system leading to improved treatment monitoring for patients on anticoagulation therapy. For the cohort of the 357 patients in the registry, the no-show rate decreased from 31 percent (preimplementation) to 21 percent (postimplementation).
AHRQ-funded; HS023558; HS021322.
Citation: Lee SY, Cherian R, Ly I .
Designing and implementing an electronic patient registry to improve warfarin monitoring in the ambulatory setting.
Jt Comm J Qual Patient Saf 2017 Jul;43(7):353-60. doi: 10.1016/j.jcjq.2017.03.006.
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Keywords: Health Information Technology (HIT), Registries, Blood Thinners, Medication, Ambulatory Care and Surgery
Palamaner Subash Shantha G, Bhave PD, Girotra S
Sex-specific comparative effectiveness of oral anticoagulants in elderly patients with newly diagnosed atrial fibrillation.
This study assessed the sex-specific, comparative effectiveness of direct oral anticoagulants (rivaroxaban and dabigatran), compared to each other and to warfarin among patients with atrial fibrillation. It concluded that the reduced risk of ischemic stroke in patients taking rivaroxaban, compared with dabigatran and warfarin, seems to be limited to men, whereas the higher risk of bleeding seems to be limited to women.
AHRQ-funded; HS023104.
Citation: Palamaner Subash Shantha G, Bhave PD, Girotra S .
Sex-specific comparative effectiveness of oral anticoagulants in elderly patients with newly diagnosed atrial fibrillation.
Circ Cardiovasc Qual Outcomes 2017 Apr;10(4). doi: 10.1161/circoutcomes.116.003418.
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Keywords: Elderly, Heart Disease and Health, Blood Thinners, Medication, Comparative Effectiveness, Cardiovascular Conditions, Sex Factors, Patient-Centered Outcomes Research, Evidence-Based Practice
Jones CE, Hollis RH, Gullick AA
Venous thromboembolic events: how low can you go?
This study evaluated postoperative venous thromboembolism (VTE) chemical prophylaxis adherence to assess the preventability of VTEs. It found that nearly half of patients who experienced postoperative VTEs received appropriate guideline-driven care. Most interruptions in chemical prophylaxis were justified medically. This further questions the preventability of postoperative VTEs and the utility of this outcome as a valid measure of hospital quality.
AHRQ-funded; HS013852.
Citation: Jones CE, Hollis RH, Gullick AA .
Venous thromboembolic events: how low can you go?
Am J Surg 2017 Apr;213(4):706-10. doi: 10.1016/j.amjsurg.2016.10.037.
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Keywords: Adverse Events, Blood Clots, Blood Thinners, Patient-Centered Outcomes Research, Prevention
Hart R, Veenstra DL, Boudreau DM
Impact of body mass index and genetics on warfarin major bleeding outcomes in a community setting.
The researchers conducted a case-control study to evaluate the association between body mass index and major bleeding risk among patients receiving warfarin. They found that obese patients had significantly lower major bleeding risk relative to non-obese patients . An exploratory analysis indicated a statistically significant interaction between CYP4F2*3 genetic status and obesity.
AHRQ-funded; HS022982.
Citation: Hart R, Veenstra DL, Boudreau DM .
Impact of body mass index and genetics on warfarin major bleeding outcomes in a community setting.
Am J Med 2017 Feb;130(2):222-28. doi: 10.1016/j.amjmed.2016.08.017.
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Keywords: Blood Thinners, Obesity, Patient-Centered Outcomes Research, Risk, Adverse Events
Vaughan Sarrazin MS, Jones M, Mazur A
Cost of hospital admissions in Medicare patients with atrial fibrillation taking warfarin, dabigatran, or rivaroxaban.
The purpose of this study was to examine the impact of anticoagulant choice on inpatient costs in patients with nonvalvular atrial fibrillation (AF). Analysis used 3-way propensity matching to create groups from AF patients taking dabigatran, rivaroxaban, or warfarin, and were plausible candidates for all 3 anticoagulants. Predicted values from two models were multiplied together to estimate expected costs per patient-year. The study concludes from its data that patients with newly diagnosed AF taking 150 mg dabigatran or 20 mg rivaroxaban experience lower annual inpatient costs than patients taking warfarin, due to fewer hospital admissions for stroke, non-gastrointestinal-related hemorrhages, and heart failure events.
AHRQ-funded; HS023104.
Citation: Vaughan Sarrazin MS, Jones M, Mazur A .
Cost of hospital admissions in Medicare patients with atrial fibrillation taking warfarin, dabigatran, or rivaroxaban.
J Am Coll Cardiol 2017 Jan 24;69(3):360-62. doi: 10.1016/j.jacc.2016.11.023..
Keywords: Blood Thinners, Heart Disease and Health, Medication, Healthcare Costs, Medicare, Hospitalization, Cardiovascular Conditions
O'Brien EC, Simon DN, Thomas LE
The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation.
The researchers sought to develop and validate a novel bleeding risk score using routinely available clinical information to predict major bleeding in a large, community-based in atrial fibrillation (AF) population. They concluded that their five-element ORBIT bleeding risk score had better ability to predict major bleeding in AF patients when compared with HAS-BLED and ATRIA risk scores.
AHRQ-funded; HS021092.
Citation: O'Brien EC, Simon DN, Thomas LE .
The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation.
Eur Heart J 2015 Dec 7;36(46):3258-64. doi: 10.1093/eurheartj/ehv476.
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Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Adverse Drug Events (ADE), Adverse Events, Risk, Registries, Patient-Centered Outcomes Research, Evidence-Based Practice
Zhou M, Chang HY, Segal JB
Adherence to a novel oral anticoagulant among patients with atrial fibrillation.
The researchers examined adherence and persistence to dabigatran among adults with atrial fibrillation. Among those using dabigatran alone (n = 2,713), 41 percent were nonadherent with therapy, and 32 percent had gaps of 60 days or greater. Among those observed for 9 months who used dabigatran alone, rates of nonadherence were 47 percent, whereas 48 percent discontinued therapy during follow-up.
AHRQ-funded; HS018960.
Citation: Zhou M, Chang HY, Segal JB .
Adherence to a novel oral anticoagulant among patients with atrial fibrillation.
J Manag Care Spec Pharm 2015 Nov;21(11):1054-62. doi: 10.18553/jmcp.2015.21.11.1054.
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Keywords: Blood Thinners, Patient Adherence/Compliance, Heart Disease and Health, Cardiovascular Conditions, Medication
Wyss R, Ellis AR, Brookhart MA
Matching on the disease risk score in comparative effectiveness research of new treatments.
The researchers used simulations and an empirical example to evaluate the performance of disease risk score (DRS) matching compared with propensity score (PS) matching when controlling large numbers of covariates in settings involving newly introduced treatments. When PS distributions are separated, DRS matching can improve the precision of effect estimates and allow researchers to evaluate the treatment effect in a larger proportion of the treated population.
AHRQ-funded; HS017950.
Citation: Wyss R, Ellis AR, Brookhart MA .
Matching on the disease risk score in comparative effectiveness research of new treatments.
Pharmacoepidemiol Drug Saf 2015 Sep;24(9):951-61. doi: 10.1002/pds.3810.
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Keywords: Comparative Effectiveness, Research Methodologies, Blood Thinners, Medication
Duconge J, Cadilla CL, Seip RL
Why admixture matters in genetically-guided therapy: missed targets in the COAG and EU-PACT trials.
It is now well recognized that these commonly used pharmacogenetic algorithms perform poorly when applied to people with substantial African heritage. The authors of this letter conclude that the best approach for global pharmacogenetics is to guide warfarin dosing by using a pharmacogenetic-based algorithm that also accounts for the effect of admixture or ancestry proportions.
AHRQ-funded; HS022304.
Citation: Duconge J, Cadilla CL, Seip RL .
Why admixture matters in genetically-guided therapy: missed targets in the COAG and EU-PACT trials.
P R Health Sci J 2015 Sep;34(3):175-7..
Keywords: Racial and Ethnic Minorities, Genetics, Blood Thinners, Medication
Hess CN, Peterson ED, Peng SA
Use and outcomes of triple therapy among older patients with acute myocardial infarction and atrial fibrillation.
The authors sought to determine appropriate antithrombotic therapy for acute myocardial infarction (MI) patients with atrial fibrillation (AF) treated with percutaneous coronary intervention (PCI). They found that approximately 1 in 4 older AF patients undergoing PCI for MI were discharged on triple therapy. Those receiving triple therapy versus dual antiplatelet therapy had higher rates of major bleeding without a measurable difference in composite MI, death, or stroke.
AHRQ-funded; HS021092.
Citation: Hess CN, Peterson ED, Peng SA .
Use and outcomes of triple therapy among older patients with acute myocardial infarction and atrial fibrillation.
J Am Coll Cardiol 2015 Aug 11;66(6):616-27. doi: 10.1016/j.jacc.2015.05.062.
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Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Medication
Roth JA, Bradley K, Thummel KE
Alcohol misuse, genetics, and major bleeding among warfarin therapy patients in a community setting.
The researchers conducted a case–control study to assess the association between screening positive for moderate/severe alcohol misuse and the risk of major bleeding in a community sample of patients using warfarin. They found that alcohol screening questionnaires, potentially coupled with genetic testing, could have clinical utility in selecting patients for warfarin therapy, as well as refining dosing and monitoring practices.
AHRQ-funded; HS022982.
Citation: Roth JA, Bradley K, Thummel KE .
Alcohol misuse, genetics, and major bleeding among warfarin therapy patients in a community setting.
Pharmacoepidemiol Drug Saf 2015 Jun;24(6):619-27. doi: 10.1002/pds.3769..
Keywords: Alcohol Use, Blood Thinners, Community-Based Practice, Substance Abuse
O'Brien EC, Kim S, Hess PL
Effect of the 2014 atrial fibrillation guideline revisions on the proportion of patients recommended for oral anticoagulation.
Researchers assessed the potential effect of a new guideline for atrial fibrillation (AF) by comparing the proportion of patients with AF recommended for oral anticoagulation (OAC) under the 2011 and 2014 guidelines. They found that two-thirds of patients with AF who were previously not recommended for OAC are newly recommended under the 2014 guideline. They advised future studies evaluating longitudinal changes in anticoagulation treatment patterns and outcomes among patients reclassified by the new guidelines.
AHRQ-funded; HS021092.
Citation: O'Brien EC, Kim S, Hess PL .
Effect of the 2014 atrial fibrillation guideline revisions on the proportion of patients recommended for oral anticoagulation.
JAMA Intern Med 2015 May;175(5):848-50. doi: 10.1001/jamainternmed.2015.13.
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Keywords: Heart Disease and Health, Blood Thinners, Guidelines, Medication, Cardiovascular Conditions, Evidence-Based Practice, Patient-Centered Outcomes Research
Chopra V, Fallouh N, McGuirk H
Patterns, risk factors and treatment associated with PICC-DVT in hospitalized adults: a nested case-control study.
The purpose of this study was to determine patterns, risk factors and treatment related to peripherally inserted central catheters-deep vein thrombosis (PICC-DVT) in hospitalized patients. It found that treatment for PICC-DVT varied and included heparin bridging, low molecular weight heparin only and device removal only; the average duration of treatment also varied across these groups.
AHRQ-funded; HS022835.
Citation: Chopra V, Fallouh N, McGuirk H .
Patterns, risk factors and treatment associated with PICC-DVT in hospitalized adults: a nested case-control study.
Thromb Res 2015 May;135(5):829-34. doi: 10.1016/j.thromres.2015.02.012..
Keywords: Patient Safety, Blood Clots, Blood Thinners, Risk, Hospitalization
Lauffenburger JC, Farley JF, Gehi AK
Effectiveness and safety of dabigatran and warfarin in real-world US patients with non-valvular atrial fibrillation: a retrospective cohort study.
The researchers compared the effectiveness and safety of the new oral anticoagulant, dabigatran, with warfarin in clinical practice among a large nationally representative retrospective cohort of commercially insured patients in the United States. They found that compared with warfarin, dabigatran was associated with a lower risk of ischemic stroke or systemic embolism, hemorrhagic stroke, and acute myocardial infarction.
AHRQ-funded; HS023099.
Citation: Lauffenburger JC, Farley JF, Gehi AK .
Effectiveness and safety of dabigatran and warfarin in real-world US patients with non-valvular atrial fibrillation: a retrospective cohort study.
J Am Heart Assoc 2015 Apr 10;4(4):e001798. doi: 10.1161/jaha.115.001798..
Keywords: Comparative Effectiveness, Blood Thinners, Patient-Centered Outcomes Research, Stroke, Heart Disease and Health