National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (10)
- Adverse Events (6)
- Ambulatory Care and Surgery (1)
- Blood Clots (6)
- (-) Blood Thinners (30)
- Brain Injury (1)
- Cardiovascular Conditions (13)
- Care Management (3)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (1)
- Comparative Effectiveness (4)
- COVID-19 (1)
- Data (1)
- Diagnostic Safety and Quality (1)
- Elderly (2)
- Electronic Health Records (EHRs) (2)
- Emergency Medical Services (EMS) (1)
- Evidence-Based Practice (6)
- Guidelines (1)
- Healthcare Cost and Utilization Project (HCUP) (2)
- Healthcare Costs (2)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (4)
- Heart Disease and Health (9)
- Hospitalization (3)
- Hospitals (1)
- Implementation (1)
- Injuries and Wounds (1)
- Medicare (1)
- Medication (25)
- Medication: Safety (2)
- Obesity (1)
- Outcomes (6)
- Patient-Centered Outcomes Research (7)
- Patient Adherence/Compliance (1)
- Patient Safety (4)
- Prevention (4)
- Racial and Ethnic Minorities (1)
- Registries (1)
- Research Methodologies (1)
- Risk (4)
- Sex Factors (1)
- Shared Decision Making (1)
- Social Determinants of Health (1)
- Stroke (3)
- Surgery (2)
- 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 25 of 30 Research Studies DisplayedKravchenko OV, Boyce RD, Gomez-Lumbreras A
Drug-drug interaction between dexamethasone and direct-acting oral anticoagulants: a nested case-control study in the national COVID cohort collaborative (N3C).
This study examined whether there is an association between thromboembolotic events (TEEs) and concomitant use of dexamethasone with either apixaban or rivaroxaban (both direct oral anticoagulants or DOACs) during treatment for COVID-19. The authors used data from the National COVID Cohort Collaborative (N3C) to conduct a nested case-control study. Eligible participants were adults over 18 years who were exposed to a DOAC for 10 or more consecutive days and exposure to dexamethasone at least 5 or more consecutive days. The study did not find a discernible association of TEE in patients concomitantly exposed to dexamethasone and a DOAC.
AHRQ-funded; HS025984.
Citation: Kravchenko OV, Boyce RD, Gomez-Lumbreras A .
Drug-drug interaction between dexamethasone and direct-acting oral anticoagulants: a nested case-control study in the national COVID cohort collaborative (N3C).
BMJ Open 2022 Dec 29; 12(12):e066846. doi: 10.1136/bmjopen-2022-066846..
Keywords: COVID-19, Blood Thinners, Medication, Adverse Drug Events (ADE), Adverse Events, Cardiovascular Conditions, Medication: Safety, Patient Safety
Pannucci CJ, Fleming KI, Varghese TK
Low anti-factor Xa level predicts 90-day symptomatic venous thromboembolism in surgical patients receiving enoxaparin prophylaxis: a pooled analysis of eight clinical trials.
This study examined whether low anti-factor Xa (aFXa) level predicts 90-day symptomatic venous thromboembolism (VTE) in surgical patients receiving enoxaparin prophylaxis. The authors conducted a pooled analysis of 8 clinical trials from a single institution over a 4-year period. Among 985 patients, 2.3% had symptomatic 90-day VTE, 4.2% had 90-day clinically relevant bleeding, and 2.1% had major bleeding. Patients with initial low aFXa were significantly more likely to have 90-day VTE than patients with adequate or high xFXa (4.2% vs 1.3%). This relationship was significant for patients who received enoxaparin twice daily as opposed to once a day. No association was seen between high xFXa and 90-day clinically relevant bleeding or major bleeding.
AHRQ-funded; HS024326.
Citation: Pannucci CJ, Fleming KI, Varghese TK .
Low anti-factor Xa level predicts 90-day symptomatic venous thromboembolism in surgical patients receiving enoxaparin prophylaxis: a pooled analysis of eight clinical trials.
Ann Surg 2022 Dec 1;276(6):e682-e90. doi: 10.1097/sla.0000000000004589..
Keywords: Blood Thinners, Surgery, Medication, Blood Clots
Gomez Lumbreras A, Reese TJ, Del Fiol G
Shared decision-making for drug-drug interactions: formative evaluation of an anticoagulant drug interaction.
This study evaluated a tool called DDInteract that was developed to enhance and support shared decision-making (SDM) between patients and physicians when both warfarin and NSAIDs are used concurrently. The study used case vignettes with physicians and patients on warfarin to conduct simulated virtual clinical encounters where they discussed the use of taking ibuprofen and warfarin concurrently and determined an appropriate therapeutic plan based on the patient’s individualized risk. Participants completed a postsession interview and SDM process survey, including the 9-item Shared Decision-Making Questionnaire (SDM-Q-9), tool usability and workload National Aeronautics and Space Administration (NASA) Task Load Index, Unified Theory of Acceptance and Use of Technology (UTAUT), Perceived Behavioral Control (PBC) scale, System Usability Scale (SUS), and Decision Conflict Scale (DCS). A total of 12 physician-patient dyads were used, with over 91% of the patients over 50 and 75% had been taking warfarin for over 2 years. Most participants rated DDInteract higher than usual care (UC) and would be willing to use the tool for an interaction involving warfarin and NSAIDs.
AHRQ-funded; HS027099.
Citation: Gomez Lumbreras A, Reese TJ, Del Fiol G .
Shared decision-making for drug-drug interactions: formative evaluation of an anticoagulant drug interaction.
JMIR Form Res 2022 Oct 19;6(10):e40018. doi: 10.2196/40018..
Keywords: Shared Decision Making, Medication, Blood Thinners, Clinical Decision Support (CDS), Health Information Technology (HIT), Medication: Safety, Patient Safety
Sharma AE, Khoong EC, Rivadeneira N
Warfarin monitoring in safety-net health systems: analysis by race/ethnicity and language preference.
This study’s objective was to determine if there were any race/ethnicity or language disparities in warfarin monitoring in safety-net systems using differences in international normalized ratio (INR) monitoring. This cross-section analysis used process and safety data shared from the Safety Promotion Action Research and Knowledge Network (SPARK-Net) initiative, a consortium of five California safety-net hospital systems. A total of 8129 patients were included: 3615 (44%) were female; 1470 (18%), Black/African American; 3354 (41%), Hispanic/Latinx; 1210 (15%), Asian; 1643 (20%), White; and 452 (6%), other. A total of 45% were non-English preferring. The authors did not observe statistically significant disparities in the rate of appropriate INR monitoring by race/ethnicity or language. The primary source of variation was by healthcare network.
AHRQ-funded; HS024426.
Citation: Sharma AE, Khoong EC, Rivadeneira N .
Warfarin monitoring in safety-net health systems: analysis by race/ethnicity and language preference.
J Gen Intern Med 2022 Aug;37(11):2703-10. doi: 10.1007/s11606-021-07283-6..
Keywords: Blood Thinners, Medication, Racial and Ethnic Minorities
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
Meng T, Trickey AM, Harris AHS
Lessons learned from the historical trends on thrombolysis use for acute ischemic stroke among Medicare beneficiaries in the United States.
The authors’ objectives were to assess and validate the change in intravenous thrombolysis (IVT) utilization in a national sample of Medicare beneficiaries and to examine the effect of patient, stroke center designation, and geography on IVT utilization. They found that, between 2007 and 2014, the frequency of IVT for patients with acute ischemic stroke increased substantially, though differences persisted in the form of less frequent treatment associated with certain characteristics.
AHRQ-funded; HS026207.
Citation: Meng T, Trickey AM, Harris AHS .
Lessons learned from the historical trends on thrombolysis use for acute ischemic stroke among Medicare beneficiaries in the United States.
Front Neurol 2022 Mar 4;13:827965. doi: 10.3389/fneur.2022.827965..
Keywords: Stroke, Cardiovascular Conditions, Blood Thinners
Barnes GD, Sippola E, Ranusch A
Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process.
This study examined the implementation of electronic dashboards and the key barriers that were found. Semi-structured interviews were conducted at the national Veterans Health Affairs (VA) following implementation of a population health tool, and in Michigan for the Michigan Anticoagulation Quality Improvement Initiative (MAQI(2) dashboard tool designed for pharmacist or nurse use to monitor safe outpatient anticoagulant prescribing by physicians and other clinicians. A total of 45 stakeholders were interviewed, 32 at the VA, and 13 at MAQI(2). Five key determinants of implementation success were identified: (1) clinician authority and autonomy, (2) clinician self-identity and job satisfaction, (3) documentation and administrative needs, (4) staffing and work schedule, and (5) integration with existing information systems. Key differences between the two contexts included concerns about IT support and prioritization within MAQI(2) prior to implementation but not VHA after implementation and also concerns about authority and autonomy.
AHRQ-funded; HS026874.
Citation: Barnes GD, Sippola E, Ranusch A .
Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process.
Implement Sci Commun 2022 Feb 2;3(1):10. doi: 10.1186/s43058-022-00262-w..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Blood Thinners, Medication, Implementation
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
Desai RJ, Wyss R, Jin Y
Extension of disease risk score-based confounding adjustments for multiple outcomes of interest: an empirical evaluation.
Use of disease risk score (DRS)-based confounding adjustment when estimating treatment effects on multiple outcomes is not well studied. In this empirical cohort study, the investigators compared dabigatran initiators and warfarin initiators with respect to risks of ischemic stroke and major bleeding in 12 sequential monitoring periods (90 days each), using data from the Truven Marketscan database (Truven Health Analytics, Ann Arbor, Michigan).
AHRQ-funded; HS022193.
Citation: Desai RJ, Wyss R, Jin Y .
Extension of disease risk score-based confounding adjustments for multiple outcomes of interest: an empirical evaluation.
Am J Epidemiol 2018 Nov;187(11):2439-48. doi: 10.1093/aje/kwy130.
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Keywords: Blood Thinners, Cardiovascular Conditions, Medication, Outcomes, Research Methodologies, Risk, Stroke
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
Zhu J, Alexander GC, Nazarian S
Trends and variation in oral anticoagulant choice in patients with atrial fibrillation, 2010-2017.
This paper discusses trends in usage of oral anticoagulants in patients with atrial fibrillation from 2010 to 2017. Since 2010, several non-vitamin K antagonist oral coagulants (NOACs) have been brought to the US market. This study examined trends in usage. A cross-sectional analysis of medical and pharmacy claims was done for commercial and Medicare Advantage enrollees in a large, private, US Health plan. A total of 112,187 adults with nonvalvular AF starting OACs was identified. In the first quarter of 2017, out of 7502 patients starting OACs, 78.9% used NOACs and 21.1% warfarin. Usage of regular anticoagulants such as apixaban increases with age, female sex, stroke or bleeding risk and comorbidities. Warfarin and apixaban are generally preferred for elderly patients and patients with higher stroke or bleeding risk.
AHRQ-funded; HS024737.
Citation: Zhu J, Alexander GC, Nazarian S .
Trends and variation in oral anticoagulant choice in patients with atrial fibrillation, 2010-2017.
Pharmacotherapy 2018 Sep;38(9):907-20. doi: 10.1002/phar.2158..
Keywords: Blood Thinners, Cardiovascular Conditions, Healthcare Utilization, Heart Disease and Health, Medication
Turner TE, Saeed MJ, Novak E
Association of inferior vena cava filter placement for venous thromboembolic disease and a contraindication to anticoagulation with 30-day mortality.
Despite the absence of data from randomized clinical trials, professional societies recommend inferior vena cava (IVC) filters for patients with venous thromboembolic disease (VTE) and a contraindication to anticoagulation therapy. Prior observational studies of IVC filters have suggested a mortality benefit associated with IVC filter insertion but have often failed to adjust for immortal time bias. The purpose of this study was to determine the association of IVC filter placement with 30-day mortality after adjustment for immortal time bias.
AHRQ-funded; HS019455.
Citation: Turner TE, Saeed MJ, Novak E .
Association of inferior vena cava filter placement for venous thromboembolic disease and a contraindication to anticoagulation with 30-day mortality.
JAMA Netw Open 2018 Jul 6;1(3):e180452. doi: 10.1001/jamanetworkopen.2018.0452.
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Keywords: Blood Thinners, Cardiovascular Conditions, Care Management, Heart Disease and Health, Healthcare Cost and Utilization Project (HCUP), Medication, Outcomes
Pannucci CJ, Fleming KI, Agarwal J
The impact of once- versus twice-daily enoxaparin prophylaxis on risk for venous thromboembolism and clinically relevant bleeding.
This study compared pharmacodynamic and clinical outcomes, including 90-day venous thromboembolism and 90-day clinically relevant bleeding, between two prospectively performed clinical trials whose sole difference was postoperative anticoagulation strategy. The investigators concluded that twice-daily enoxaparin was superior to once-daily enoxaparin for 90-day acute venous thromboembolism risk reduction. They suggested that twice-daily enoxaparin may increase clinically relevant bleeding, although they indicate that observed differences in their study were not significant.
AHRQ-funded; HS024326.
Citation: Pannucci CJ, Fleming KI, Agarwal J .
The impact of once- versus twice-daily enoxaparin prophylaxis on risk for venous thromboembolism and clinically relevant bleeding.
Plast Reconstr Surg 2018 Jul;142(1):239-49. doi: 10.1097/prs.0000000000004517..
Keywords: Blood Thinners, Medication, Outcomes
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
Childers CP, Maggard-Gibbons M, Ulloa JG
Perioperative management of antiplatelet therapy in patients undergoing non-cardiac surgery following coronary stent placement: a systematic review.
Researchers conducted a systematic review on the use of antiplatelet therapy (APT) after non-cardiac surgery (NCS) following stent placement surgery done previously. There has been some debate among the American College of Cardiology and American Heart Association as to the guidelines of how long to delay NCS after stent placement. Out of 4,882 articles, only 16 were included in the review. All of them were small. Reviewers looked for rates of cardiac events and/or bleeding events with the different APT strategies used. There did not seem to be much difference in outcomes between the different strategies.
AHRQ-funded; HS025079.
Citation: Childers CP, Maggard-Gibbons M, Ulloa JG .
Perioperative management of antiplatelet therapy in patients undergoing non-cardiac surgery following coronary stent placement: a systematic review.
Syst Rev 2018 Jan 10;7(1):4. doi: 10.1186/s13643-017-0635-z..
Keywords: Adverse Drug Events (ADE), Blood Thinners, Cardiovascular Conditions, Care Management, Medication, Outcomes, Surgery
Lau BD, Streiff MB, Kraus PS
Missed doses of venous thromboembolism (VTE) prophylaxis at community hospitals: cause for alarm.
This study examined the rate of missed doses of venous thromboembolism (VTE) prophylaxis at community hospitals in the Washington, DC and greater Baltimore metropolitan areas. This retrospective study included four hospitals within the Johns Hopkins Health System. Non-administration of VTE prophylaxis was found 10.9% to 15.0% of the time among the three community hospitals. About 43.6% of patients missed at least one dose in all four hospitals. The investigators weren’t able to categorize patients by specialty, however it has been reported that more doses are missed with medically ill patients than other hospitalized patients.
AHRQ-funded; HS024547.
Citation: Lau BD, Streiff MB, Kraus PS .
Missed doses of venous thromboembolism (VTE) prophylaxis at community hospitals: cause for alarm.
J Gen Intern Med 2018 Jan;33(1):19-20. doi: 10.1007/s11606-017-4203-y..
Keywords: Blood Clots, Prevention, Blood Thinners, Patient Adherence/Compliance, Medication, Hospitals
Fan 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