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001-es BibID:	BIBFORM043400
Első szerző:	Kristoffersen, Ann-Helen
Cím:	Interpretation and management of INR results : a case history based survey in 13 countries / Ann-Helen Kristoffersen, Geir Thue, Eva Ajzner, Neree Claes, Andrea Rita Horvath, Rina Leonetti, Kaja Kallion, Dianne Kitchen, Steve Kitchen, Marge Kutt, Piet Meijer, Mathias Muller, Elisabeth Nilsson, Carmen Perich, Inger Plum, Dunja Rogic, Rosy Tirimacco, Felix J. M. van der Meer, Joseph Watine, Sverre Sandberg
Dátum:	2012
ISSN:	0049-3848
Megjegyzések:	Introduction: Standardisation of treatment with vitamin K antagonists (VKAs) is still an issue after 60 years ofuse. 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 patientwith atrial fibrillation on stable anticoagulation (latest INR 2.3). Physicians were asked about frequencyof INR measurement, when to change the VKA dose, and the patient's annual risk of ischemic stroke andbleeding. 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 careand 18% from secondary care. Answers varied substantially within and between countries regardless of levelof care and VKA used. Median number of weeks between INR measurements was 4 ? 6 weeks. Medianthreshold INR for increasing or decreasing the VKA dose was 1.9 and 3.1, respectively. Risk of ischemic strokeand bleeding were overestimated 2 ? 3 times. In case history B, the median dose reduction the two first dayswas 75% for GPs and 55% for specialists, irrespective of estimates of bleeding risk; with one week to a repeatINR.Conclusion: Variation in VKA monitoring is substantial implying clinical consequences. Guidelines seem eitherunknown or may be considered impracticable. Further efforts towards standardisation of VKA managementare needed.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban külföldön készült közlemény
Megjelenés:	Thrombosis Research. - 130 : 3 (2012), p. 309-315. -
További szerzők:	Thue, Geir Ajzner Éva (1968-) (laboratóriumi szakorvos) Claes, Neree Horváth Andrea Rita Leonetti, Rina Kallion, Kaja Kitchen, Dianne Kitchen, Steve Kutt, Marge Meijer, Piet Muller, Mathias Nilsson, Elisabeth Perich, Carmen Plum, Inger Rogic, Dunja Tirimacco, Rosy Meer, Felix J. M. van der Watine, Joseph Sandberg, Sverre
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