Biomedical subjects
JE Ansell
Publications and source records attributed to JE Ansell.
Anticoagulation Management as a Risk Factor for Adverse Events: Grounds for Improvement.
Oral anticoagulation therapy has a high risk/benefit profile because of its narrow therapeutic index and the influence of concomitant patient characteristics. The manner in which oral anticoagulation is managed is seldom mentioned as a risk factor for adverse events, but recent studies identify it as such. There are two general models of anticoagulation management, characterized as routine medical care and coordinated care. The literature suggests a rate of major hemorrhage of approximately 10% under the former model, compared with approximately 3.5% under the latter model. Similar, if not greater, differences, are seen for the rate of thrombotic events ( approximately 12% vs. 3.5%). Because of fewer adverse events, coordinated care results in cost savings due to reduced hospitalizations and emergency room visits. If the full benefit of anticoagulation is to be gained, there is a strong rationale for the development and promotion of anticoagulation management services.
Advances in the Monitoring of Oral Anticoagulation: Point-of-Care Testing, Patient Self-Monitoring, and Patient Self-Management.
Oral anticoagulation with warfarin sodium has proven to be an effective therapy for patients at risk for thromboembolic disease, but due to its high risk/benefit ratio, many physicians are reluctant to prescribe the drug. The development of capillary whole-blood prothrombin time (PT) monitors provides a potential means to decrease this risk/benefit ratio and to encourage the use of warfarin. Studies show that this technology is accurate, precise, and correlates closely with standard laboratory methods. Given that these monitors are simple and portable, investigators have conducted studies to determine their suitability for patient self-testing and home monitoring. Investigations show that patients can accurately and precisely perform the PT test at home, and that this mode of therapy appears to be at least as safe and effective as standard management. Furthermore, limited studies also suggest that patients can also manage their own dosing based on personalized guidelines designed by a physician. Given the theoretical potential for improved patient outcomes and overall cost reduction, patient self-monitoring and self-management are not far off. Large randomized prospective trials are now needed to confirm that the future of anticoagulation management should include patient self-monitoring and patient self-management of therapy.