National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Adverse Drug Events (ADE) (5)
- Adverse Events (5)
- Blood Clots (2)
- (-) Blood Thinners (13)
- Cardiovascular Conditions (9)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (1)
- Comparative Effectiveness (5)
- COVID-19 (1)
- Elderly (1)
- (-) Evidence-Based Practice (13)
- Guidelines (2)
- Health Information Technology (HIT) (1)
- Heart Disease and Health (8)
- Kidney Disease and Health (1)
- Medication (12)
- Medication: Safety (2)
- Outcomes (4)
- Patient-Centered Outcomes Research (10)
- Patient Safety (2)
- Practice Patterns (1)
- Prevention (1)
- Provider: Pharmacist (1)
- Registries (2)
- Risk (3)
- Sex Factors (1)
- Stroke (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 13 of 13 Research Studies DisplayedSmith SN, Lanham M, Seagull FJ
Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial.
This article described a study designed to improve existing alert systems for direct oral anticoagulant medications (DOAC) by testing novel alerts that encourage collaboration between prescribers and expert pharmacists working in anticoagulation clinics. Its goals were to determine the effect of notifications targeting existing inappropriate DOAC prescriptions, to examine the effect of alerts on newly prescribed inappropriate DOACs, and to examine changes in the magnitude of effects over time for both the new and existing prescription alerts. Prescribing healthcare providers would be randomized to different types of electronic health record medication alerts when a patient has an unsafe anticoagulant prescription; the authors identified which alerts are most effective at encouraging evidence-based prescribing.
AHRQ-funded; HS028562.
Citation: Smith SN, Lanham M, Seagull FJ .
Implementing pharmacist-prescriber collaboration to improve evidence-based anticoagulant use: a randomized trial.
Implement Sci 2023 May 15; 18(1):16. doi: 10.1186/s13012-023-01273-4..
Keywords: Provider: Pharmacist, Blood Thinners, Medication, Evidence-Based Practice
Djulbegovic B, Hozo I, Lizarraga D
Evaluation of a fast-and-frugal clinical decision algorithm ('pathways') on clinical outcomes in hospitalised patients with COVID-19 treated with anticoagulants.
The objective of this study was to assess if delivery of anticoagulant prophylaxis according to an algorithm improved clinical outcomes in patients hospitalized with COVID-19 in comparison with anticoagulant treatment given at individual practitioners' discretion. Findings indicated that the algorithm did not reduce death, venous thromboembolism, nor major bleeding, but helped avoid longer hospital stay and admission to an intensive-care unit.
AHRQ-funded; HS024917.
Citation: Djulbegovic B, Hozo I, Lizarraga D .
Evaluation of a fast-and-frugal clinical decision algorithm ('pathways') on clinical outcomes in hospitalised patients with COVID-19 treated with anticoagulants.
J Eval Clin Pract 2023 Feb; 29(1):3-12. doi: 10.1111/jep.13780..
Keywords: COVID-19, Clinical Decision Support (CDS), Blood Thinners, Medication, Evidence-Based Practice, Health Information Technology (HIT)
Barkun AN, Douketis J, Noseworthy PA
Management of patients on anticoagulants and antiplatelets during acute gastrointestinal bleeding and the peri-endoscopic period: a clinical practice guideline dissemination tool.
The American College of Gastroenterology and the Canadian Association of Gastroenterology jointly created recommendations on the management of anticoagulants and antiplatelets during acute gastrointestinal (GI) bleeding and the elective per-endoscopic period. The clinical practice guideline (CPG) panel was restricted in making strong recommendations regarding some relevant clinical questions because of the limited certainty of evidence in the literature. The purpose of this paper was to describe a clinical practice guideline dissemination tool for the management of patients on anticoagulants and antiplatelets during acute gastrointestinal bleeding and the peri-endoscopic period. The dissemination tool addresses provider concerns about limited certainty of evidence in the literature by providing clinicians with a companion piece to execute recommendations with contextual guidance and practical algorithms. The patient’s risks of a thromboembolic event versus the procedural risk of GI bleeding is taken into account in the implementation of the tool. The authors concluded that the clinical practice guideline dissemination tool provides both contextual information in interpreting the clinical guideline panel’s recommendations and algorithmic guidance for common scenarios encountered during endoscopic practice.
AHRQ-funded; HS025402.
Citation: Barkun AN, Douketis J, Noseworthy PA .
Management of patients on anticoagulants and antiplatelets during acute gastrointestinal bleeding and the peri-endoscopic period: a clinical practice guideline dissemination tool.
Am J Gastroenterol 2022 Apr;117(4):513-19. doi: 10.14309/ajg.0000000000001688..
Keywords: Blood Thinners, Medication, Adverse Drug Events (ADE), Adverse Events, Evidence-Based Practice, Guidelines
Yao X, Inselman JW, Ross JS
Comparative effectiveness and safety of oral anticoagulants across kidney function in patients with atrial fibrillation.
Patients with atrial fibrillation and severely decreased kidney function were excluded from the pivotal non-vitamin K antagonist oral anticoagulants (NOAC) trials, thereby raising questions about comparative safety and effectiveness in patients with reduced kidney function. This study aimed to compare oral anticoagulants across the range of kidney function in patients with atrial fibrillation.
AHRQ-funded; HS025517; HS025164; HS025402; HS022882; HS024075.
Citation: Yao X, Inselman JW, Ross JS .
Comparative effectiveness and safety of oral anticoagulants across kidney function in patients with atrial fibrillation.
Circ Cardiovasc Qual Outcomes 2020 Oct;13(10):e006515. doi: 10.1161/circoutcomes.120.006515..
Keywords: Kidney Disease and Health, Cardiovascular Conditions, Blood Thinners, Medication, Medication: Safety, Patient Safety, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Villa Zapata L, Hansten PD, Panic J
Risk of bleeding with exposure to warfarin and nonsteroidal anti-inflammatory drugs: a systematic review and meta-analysis.
Warfarin use can trigger the occurrence of bleeding independently or as a result of a drug-drug interaction when used in combination with nonsteroidal anti-inflammatory drugs (NSAIDs). This article examines the risk of bleeding in individuals exposed to concomitant warfarin and NSAID compared with those taking warfarin alone. The investigators concluded that risk of bleeding was significantly increased among persons taking warfarin and a NSAID or COX-2 inhibitor together as compared with taking warfarin alone.
AHRQ-funded; HS025984.
Citation: Villa Zapata L, Hansten PD, Panic J .
Risk of bleeding with exposure to warfarin and nonsteroidal anti-inflammatory drugs: a systematic review and meta-analysis.
Thromb Haemost 2020 Jul;120(7):1066-74. doi: 10.1055/s-0040-1710592..
Keywords: Blood Thinners, Medication, Medication: Safety, Risk, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes
Lowenstern A, Al-Khatib SM, Sharan L
Interventions for preventing thromboembolic events in patients with atrial fibrillation: a systematic review.
The purpose of this review was to compare the effectiveness of therapies to prevent thromboembolic events and bleeding complications in adults with nonvalvular atrial fibrillation (AF). Two independent reviewers screened citations in order to identify comparative studies of treatments to prevent stroke in adults with nonvalvular AF who reported thromboembolic or bleeding complications, then abstracted data from 220 selected articles, assessed study quality and applicability, and rated the strength of evidence. The article concludes that available direct-acting oral anticoagulants (DOACs) are at least as effective and safe as warfarin for patients with nonvalvular AF and had similar benefits across several patient subgroups.
AHRQ-funded; 290201500004I.
Citation: Lowenstern A, Al-Khatib SM, Sharan L .
Interventions for preventing thromboembolic events in patients with atrial fibrillation: a systematic review.
Ann Intern Med 2018 Dec 4;169(11):774-87. doi: 10.7326/m18-1523..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Blood Thinners, Adverse Drug Events (ADE), Adverse Events, Medication, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice
Borre ED, Goode A, Raitz G
Predicting thromboembolic and bleeding event risk in patients with non-valvular atrial fibrillation: a systematic review.
This systematic review compared the strength of tools to predict stroke and bleeding risk in patients with atrial fibrillation (AF) taking blood thinners. Sixty-one studies were found to predict thromboembolic risk and 38 to predict bleeding risk.
AHRQ-funded; 290201500004I.
Citation: Borre ED, Goode A, Raitz G .
Predicting thromboembolic and bleeding event risk in patients with non-valvular atrial fibrillation: a systematic review.
Thromb Haemost 2018 Dec;118(12):2171-87. doi: 10.1055/s-0038-1675400..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Stroke, Blood Clots, Blood Thinners, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Patient-Centered Outcomes Research, Evidence-Based Practice
Mentias A, Shantha G, Chaudhury P
Assessment of outcomes of treatment with oral anticoagulants in patients with atrial fibrillation and multiple chronic conditions: a comparative effectiveness analysis.
The purpose of this retrospective comparative effectiveness analysis was to determine whether there are differences in efficacy and safety of dabigatran, rivaroxaban, and warfarin regarding stroke prevention and bleeding rates, respectively, in elderly patients with atrial fibrillation (AF) with multiple chronic conditions (MCC). The investigators concluded that oral anticoagulants were similarly effective in stroke prevention among patients with AF with MCC. However, the indicate that dabigatran and rivaroxaban use may be associated with lower rates of mortality in patients with MCC.
AHRQ-funded; HS023104.
Citation: Mentias A, Shantha G, Chaudhury P .
Assessment of outcomes of treatment with oral anticoagulants in patients with atrial fibrillation and multiple chronic conditions: a comparative effectiveness analysis.
JAMA Netw Open 2018 Sep 7;1(5):e182870. doi: 10.1001/jamanetworkopen.2018.2870..
Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Outcomes, Patient-Centered Outcomes Research, Medication, Evidence-Based Practice, Comparative Effectiveness, Chronic Conditions
Wang SV, Huybrechts KF, Fischer MA
Generalized boosted modeling to identify subgroups where effect of dabigatran versus warfarin may differ: an observational cohort study of patients with atrial fibrillation.
The purpose of this study was to explore generalized boosted modeling (GBM) as a method for identifying subgroups with greater benefit or harm with dabigatran versus warfarin for treatment of atrial fibrillation. The investigators concluded that dabigatran's superiority to warfarin at prevention of thromboembolism may be greater in secondary than primary prevention. They indicated that in practice, secondary prevention patients are more often treated with warfarin.
AHRQ-funded; HS022193.
Citation: Wang SV, Huybrechts KF, Fischer MA .
Generalized boosted modeling to identify subgroups where effect of dabigatran versus warfarin may differ: an observational cohort study of patients with atrial fibrillation.
Pharmacoepidemiol Drug Saf 2018 Apr;27(4):383-90. doi: 10.1002/pds.4395..
Keywords: Blood Clots, Blood Thinners, Cardiovascular Conditions, Comparative Effectiveness, Evidence-Based Practice, Heart Disease and Health, Medication, Outcomes, Patient-Centered Outcomes Research, Prevention
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
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
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
O'Brien EC, Holmes DN, Ansell JE
Physician practices regarding contraindications to oral anticoagulation in atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry.
This study describes the frequencies of and factors associated with oral anticoagulation (OAC) contraindications in clinical practice for patients with atrial fibrillation (AF). Contraindications to OAC therapy among patients with AF are common but subjective. Many patients with reported contraindications were receiving OAC, suggesting that the perceived benefits outweighed the potential harm posed by the relative contraindication.
AHRQ-funded; HS021092
Citation: O'Brien EC, Holmes DN, Ansell JE .
Physician practices regarding contraindications to oral anticoagulation in atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry.
Am Heart J. 2014 Apr;167(4):601-609.e1. doi: 10.1016/j.ahj.2013.12.014..
Keywords: Heart Disease and Health, Blood Thinners, Medication, Registries, Cardiovascular Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice, Practice Patterns