Anticoagulation Knowledge Research Articles

Assessment of Anticoagulation Control Association with Warfarin Knowledge and Demographic Features of Iranian Population

Background: Warfarin is the most commonly used oral anticoagulant for patients with atrial fibrillation, prosthetic heart valves, and deep vein thrombosis with a narrow therapeutic index. Due to the importance of patients’ adherence to treatment and also regular measurements of International normalized ratio (INR), this can have a significant impact on the quality of anticoagulation control. Objectives: The primary aim of this study was to assess the association between warfarin knowledge and time in therapeutic range (TTR) in patients on warfarin anticoagulation for at least 6 months who were referred to anticoagulation clinic in Rajaie Heart Center during 2016 - 2017. Methods: In this cross-sectional study, 620 patients who had been referred to the outpatient Rajaie Hospital anticoagulant clinic and had been taking warfarin for over six months were asked to fill two questionnaires named anticoagulation knowledge assessment (AKA) during a 12-week period. After obtaining the necessary permits, TTR (by Rosendal method) was calculated using the INR results of patients. Results: A total of 620 patients completed the questionnaire. The relation between warfarin knowledge and anticoagulation control was not significant. The mean age of the study population was 52.45 SD ± 14.01 years. This study showed a significant relationship between TTR, duration of warfarin usage (PV = 0.03) and the underlying cause of this usage (PV = 0.016). Conclusions: Prevention of chronic diseases is one of the most important priorities of the health care systems. Reduction in complications such as thrombosis and bleeding can be achieved by efforts to promote patient’s knowledge. By recognition of relation between warfarin knowledge and social and demographic indicators, patient’s education gap can be detected and also planned for dissolving. This study showed that although many of the patients visited in anticoagulation clinic have poor anticoagulation control, but a major part of them have good knowledge of warfarin usage.

Clinical Impact of Pharmacist led Anticoagulation Services in a Tertiary Care Hospital

Background: Anticoagulants known as blood thinners, prevent or reduce blood coagulation. Anticoagulation management is a challenge as slight change in drug concentration can result in either bleed or blood clot formation. Aim of the study: The aim was to analyse the clinical impact of pharmacist-led anticoagulation services with objectives to analyse the impact of patient counselling on knowledge, attitude, practice and medication adherence of oral anticoagulation, to identify adverse drug reactions and to assess dosage initiation and dosage adjustment of anticoagulants. Method: A prospective interventional study was conducted in clinical departments of Lourdes Hospital Kochi. Medication adherence assessed using 8 item MMAS and initial baseline knowledge about oral anticoagulants collected using a validated KAP questionnaire. Patients counselled by clinical pharmacist and followed up. Dosing of parenteral anticoagulants were monitored, ADRs identified, assessed using Naranjo scale. Results: One hundred and forty-two patients (84 parenteral and 58 oral) were enrolled in the study. Major adverse reactions were hematuria and gum bleeding. Dosing related problems were identified and intervened. Statistically significant improvement in medication adherence, knowledge, attitude and practice of patients on oral anticoagulants in addition to significant improvement in time in therapeutic range were observed. The correlation coefficient was positive (p<0.01) which interpreted that as the practice increases time in therapeutic range also increases. Conclusion: Additional Care given to the intervention group by clinical pharmacist resulted in a statistically significant improvement in knowledge, attitude, practice and medication adherence supported by improvement of time in therapeutic range, which highlights the importance of clinical pharmacist in anticoagulation management.

The effect of phased written health education combined with healthy diet on the quality of life of patients after heart valve replacement

BackgroundTo observe the effect of phased written health education combined with healthy diet on the quality of life of patients after heart valve replacement.MethodsOne hundred-thirty patients who underwent heart valve replacement surgery in our hospital from January 2018 to January 2020 were enrolled as the research subjects. They were randomly divided into study group (65 patients, phased written health education combined with health Diet) and control group (65 cases, routine health education). The drug compliance and the degree of anticoagulant drugs knowledge were compared between the two groups in the first and second stage rehabilitation and the recovery stage. The health behavior ability and quality of life at different phases were also observed.ResultsDuring the first and the second stage rehabilitation, and the recovery stage, the drug compliance of the study group was superior to that of the control group, with statistical significance (P < 0.05). Meanwhile, the knowledge of anticoagulant drugs in the study group was better than that in the control group, with statistical significance (P < 0.05). Before intervention, there was no significant difference in health behavior ability and quality of life between the two groups (P > 0.05). The healthy behavior ability of study group for each stage was superior to the control group, the difference was significant (P < 0.05). The healthy behavior ability and quality of life showed the same results with statistical significance (P < 0.05).ConclusionThe use of phased written health education combined with healthy diet in patients after heart valve replacement can effectively improve patients’ medication compliance, anticoagulant drugs knowledge, healthy behavior ability and quality of life at different stages, and is worthy of clinical application.

Improving anticoagulation in sub-Saharan Africa: What are the challenges and how can we overcome them?

Patients in sub‐Saharan Africa generally have poor anticoagulation control. We review the potential reasons for this poor control, as well as the potential solutions. Challenges include the affordability and centralisation of anticoagulation care, problems with access to medicines and international normalised ratio monitoring, the lack of locally validated standardized dosing protocols, and low levels of anticoagulation knowledge among healthcare workers and patients. Increasing numbers of patients will need anticoagulation in the future because of the increasing burden of noncommunicable disease in the region. We propose that locally developed “warfarin care bundles” which address multiple anticoagulation challenges in combination may be the most appropriate solution in this setting currently.

Assessment of the warfarin anticoagulation knowledge of patients with mechanical mitral valve prosthesis and its effect on therapy adherence and relevant complications

Assessment of the warfarin anticoagulation knowledge of patients with mechanical mitral valve prosthesis and its effect on therapy adherence and relevant complications

An Analysis of Perceived and Actual Anticoagulant Knowledge among Independent Pharmacy Patients.

Deficits in knowledge of parameters surrounding anticoagulant therapy administration carry substantial risks for patient harm. Patients prescribed anticoagulants may overestimate their knowledge of anticoagulant use principles. The purpose of this study was to analyze independent pharmacy patients' perceived versus actual knowledge of their anticoagulation therapies. A 15-item survey across a dual-site pharmacy location evaluated patients' confidence in their understanding of anticoagulant prescribing parameters and their awareness of measures to take to safeguard anticoagulant therapy routines. A pharmacist reviewed patient responses to survey items referencing actual understanding of anticoagulant therapies at the conclusion of the survey. Data analyses occurred by gender, age, ethnicity, location, living situation, self-management of anticoagulants, patient perception of anticoagulant safety, and reported receipt of anticoagulant education. Linear regressions were used for statistical analyses, with significance set at p<.05. During the span of three months, 45 patients, 20 females and 25 males, completed the survey. Perceived anticoagulant knowledge did not differ significantly by demographics. Actual anticoagulant knowledge declined by over 20% between age groups 60-69 and 80-89 years old. African Americans displayed 10% lower actual anticoagulant knowledge than Caucasian Americans. This study revealed gaps in knowledge of anticoagulants among patients at an independent pharmacy. An appeal remains for more strategies to assist with knowledge of anticoagulant regimens. Healthcare institutions should continue to incorporate programs geared towards ongoing anticoagulant education, such as question and answer sessions, along with peer support mediums that foster optimal outcomes.

Association between Patients’ Knowledge and Adherence to Anticoagulants, and Its Effect on Coagulation Control

Background: Warfarin requires strict monitoring by measuring prothrombin time (PT), international normalized ratio (INR), and time in therapeutic range (TTR). Several factors can lead to poor PT/INR control including vitamin K status, medication adherence, knowledge, and quality of life. The present study aims to assess patient adherence to warfarin treatment and its correlation with INR control. Methods: A cross-sectional study was conducted between October 2017 and January 2018 at Tripoli University Hospital. Data were collected by structured questionnaires which included; demographic and clinical characteristics, the Oral Anticoagulation Knowledge (OAK) test, and the Morisky Medication Adherence Scale (MMAS-8). Results: The final analysis included 88 out of 140 patients (73.33%). There were significant differences in age range, gender, marital status, and education level between the 2 groups (poor knowledge and adequate knowledge) (p < 0.05). There was a significant positive correlation between OAK test score and TTR. Overall, 76.2% of patients were adherent to warfarin (MMAS score ≥6) and 20.45% of patients were of high adherence (MMAS score of 8). The median score was 6 (IQR 6–7). A statistically significant, strong positive correlation between adherence to medication and TTR as an indicator of INR control was found (rs[86] = 0.472, p < 0.0001). Conclusion: The study addressed and identified several areas for future improvement of patient outcomes. The implementation of new approaches to enhance patient knowledge and adherence is warranted, and measures to provide treatment for all patients that require it are needed, to improve outcomes and decrease adverse drug effects.

A Survey to Assess the Educational Needs of Clinicians in Maternal Hematology

Introduction With advancement in medical knowledge and comprehensive care more women with hematological disorders are proceeding with pregnancy. These women have unique needs during the perinatal period, where the intersection of the Hematological disease and pregnancy can mutually impact each other, resulting in significant morbidity and even mortality. Hematologists, Internal Medicine (IM) physicians and Obstetricians are increasingly faced with the complex care of these women. The aim of this study is to assess the learning needs of these stakeholders in the care of pregnant women with hematological conditions to direct the development of educational activities. Methods We conducted a cross-sectional study using a self-administered electronic questionnaire sent to Hematologists, Obstetricians, Maternal-Fetal Medicine (MFM) Specialists and IM Specialists across Canada. The study was approved by the Research Ethics Board of Sinai Health System in Toronto, Ontario. The questionnaire assessed physician characteristics, physicians' previous educational experiences in Maternal Hematology, self-assessment of knowledge and confidence in managing pregnancy in these women, and preferences for further learning activities in Maternal Hematology. The questionnaire was pilot tested by two hematology resident physicians and two MFM fellow physicians at the University of Toronto and modifications were made to the survey based on this feedback. The survey was administered electronically in English in collaboration with the Canadian Hematology Society and Canadian MFM program directors, using an online survey-distributing website, Survey Monkey™. Participation was voluntary and anonymous. Data were exported into Excel (Microsoft, Redmond, Washington, USA) for statistical analysis. Following overall descriptive analyses (frequencies and proportions), responses were further tabulated by participant specialty. Results The survey was administered from December 2019 to March 2020. 97 participants responded to the survey, and 82 (84.5%) completed it. The 15 (15.5%) incomplete surveys (completion of less than 25% of the questionnaire), were excluded from analysis. Respondents included 17 (20.7 %) MFM specialists, 21 (25.6%) Obstetricians, 34 (41.5%) hematologists and five (6.1 %) IM physicians. Half of respondents had &amp;lt; 5 years of practice (52.6%%) and there was a similar distribution of respondents with 5-10 years (12.8%) and 11-15 years (12.8%) in practice. Most respondents were female (69.6%). Overall, 38% of respondents described the quality of their prior educational experiences as 'very useful' or 'extremely useful'. Approximately half of the respondents rated their knowledge of Maternal Hematology as intermediate, 25% as beginner and 25% as advanced. The majority of Hematologists and IM specialists (64%) considered their knowledge in Maternal Hematology as 'intermediate'; specialists in Obstetrics and MFM were divided with 30.8% considering their knowledge at the 'beginner' level and 38.5% at the 'intermediate' level. Only 3.7% of respondents described their knowledge level as 'expert'. Most respondents in Obstetrics and MFM (84.2%) considered knowledge of how to diagnose venous thromboembolism during pregnancy as 'extremely important followed by knowledge of thromboprophylaxis (63.2%) and therapeutic anticoagulation during pregnancy (63.2%) (Figure 1). Amongst Hematology and IM physicians, thrombotic microangiopathy was rated by the greatest proportion of respondents (59%) as being "extremely important". For the format of educational activity, three quarters of the respondents preferred a blended learning program, which would include a combination of face-to-face teaching and technology-enhanced learning activities. Respondents predominantly (76.2%) agreed that learning collaboratively with other specialties in a combined Maternal Hematology program would be helpful. Conclusion These results suggest that an interdisciplinary learning program involving collaboration across relevant subspecialties would be preferred by participants for the teaching and learning of Maternal Hematology. A program involving blended (in-person and technology-enhanced) learning modalities was viewed favorably by participants, and should aim to incorporate various topics, which may be prioritized differently amongst specific subspecialties. Disclosures Malinowski: Alexion: Other: Advisory board; Alexion: Honoraria. Shehata:Ferring: Honoraria.

Warfarin control in Hong Kong clinical practice: a single-centre observational study

Time in therapeutic range (TTR) assesses the safety and effectiveness of warfarin therapy using the international normalised ratio. This study investigated the TTR in Hong Kong patients using both European and Japanese therapeutic ranges and patients' economic and clinical outcomes. Predictors of poor warfarin control and patient knowledge concerning warfarin therapy were assessed. A 5-month observational study with retrospective and prospective components was conducted in the Prince of Wales Hospital. The study examined electronic patient records of patients who received warfarin for at least 1 year during the period from January 2010 to August 2015. Patient knowledge was assessed via phone interview using the Oral Anticoagulation Knowledge (OAK) test. In total, 259 patients were included; 174 completed the OAK test. The calculated mean TTR was 40.2±17.1% (European therapeutic range), compared with 49.1±16.1% (Japanese therapeutic range) [P<0.001]. Mean TTR was higher in patients with atrial fibrillation than in patients with prosthetic heart valve (P<0.001). The abilities of TTR to predict clinical and economic outcomes were comparable between European and Japanese therapeutic ranges. Patients with ideal TTR had fewer clinical complications and lower healthcare costs. Patients with younger age exhibited worse TTR, as did those with concurrent use of furosemide, famotidine, or simvastatin. Mean OAK test score was 54.1%. Only 24 (13.8%) patients achieved a satisfactory overall score of ≥75% in the test. Warfarin use in Hong Kong patients was poorly controlled, regardless of indication. Patient knowledge concerning warfarin use was suboptimal; thus, additional patient education is warranted regarding warfarin.

The Positive Impact of Pharmacist Interventions Using Educational Video Technology on Patient Knowledge of and Satisfaction with Warfarin Therapy

To assess the positive impact of pharmacist interventions via an educational video on patients’ knowledge of and satisfaction with warfarin therapy . This study used a prospective pre-test/post-test design that enrolled 91 patients from an anticoagulant clinic at King Khaled University Hospital in Riyadh, Saudi Arabia. All patients completed the Anticoagulation Knowledge Assessment (AKA) and Anti-Clot Treatment Satisfaction (ACTS) scales. Afterwards, the patients watched a 10-minute educational video containing basic information about warfarin and were given relevant informative booklets. The patients were reassessed after a mean follow-up period of approximately 52 days. In total, 85 patients completed the study. The impact of the intervention on patient knowledge was highly significant (mean difference=17.7%, 95% CI = 21.75-13.58, P.

Acceptance of a potential major bleeding among patients with venous thromboembolism on long-term oral anticoagulation: the knowledge of the disease and therapy matters

BackgroundWe investigated the bleeding tolerance and its determinants in anticoagulated patients with venous thromboembolism (VTE). MethodsIn 153 outpatients after VTE which occurred in the absence of any identifiable risk factor (aged 52 ± 15.7 years, 54.9% male), anticoagulated for at least one month (for median 29, interquartile range [IQR] 11–72 months), the Bleeding Ratio was determined basing on the declared maximum number of major bleeds that patients can accept to prevent one similar recurrent VTE episode. The modified Jessa AF Knowledge Questionnaire (JAKQ-VTE) was used to assess the knowledge of VTE and anticoagulation. ResultsThe median of the Bleeding Ratio was 4 (IQR 2–6, minimum 1, maximum 10). Compared with patients with a high Bleeding Ratio (≥4 accepted bleedings, n = 91, 59.5%), those with a low Bleeding Ratio (0–3 accepted bleedings, n = 62, 40.5%) more frequently suffered from isolated deep vein thrombosis (DVT), recurrent VTE, and diabetes. The low Bleeding Ratio group had lower overall scoring in the JAKQ-VTE compared with the remainder (median, 60.4% vs 67.6%, p = 0.003). The independent predictors of a low Bleeding Ratio were: age (odds ratio [OR], 1.36; 95% confidence interval [CI] 1.06–1.75), history of isolated PE (OR, 0.24; 95% CI, 0.08–0.66), scores in the JAKQ-VTE (OR, 0.74; 95% CI, 0.57–0.95), and time since VTE diagnosis (OR, 1.05; 95% CI, 0.98–1.13). ConclusionsThe current study suggests that the acceptance of potential major bleedings is associated not only with age and clinical factors, but also with the knowledge of VTE and anticoagulation, which highlights the need for educational efforts among patients requiring long-term anticoagulant therapy.

The effect of warfarin knowledge on anticoagulation control among patients with heart valve replacement.

Background Although novel oral anticoagulants have been applied into clinical practice, warfarin remains the only approved oral anticoagulant for heart valve replacement. Currently, an increasing number of Chinese clinical pharmacists provide patients with warfarin education. However, little research to date has been carried out to evaluate the relationship between warfarin knowledge level and anticoagulation control among patients with heart valve replacement. Objective To evaluate knowledge of warfarin and the relationship between knowledge level and anticoagulation control among patients with heart valve replacement. Setting Fujian Medical University Union Hospital, China. Method A prospective and cross-sectional study was designed to evaluate the warfarin education of inpatients new to warfarin therapy using a validated Anticoagulation Knowledge Assessment questionnaire. Included patients were followed up for at least 3months. Data were retrieved from hospital databases and telephone follow up. Main outcome measure Spearman's rho correlation analysis was used to assess the relationships between time in therapeutic range and warfarin knowledge level. Results 383 patients were included. The mean age of patients was 50.3 ± 7.9years. The mean knowledge questionnaire score was 62.3 ± 8.8%. The majority of incorrect answers related to drug-warfarin interaction. Five of the frequently incorrect questions covered drugs, herbs and diet that affect warfarin therapy. There were significant correlations between total questionnaire score and time in therapeutic range (rho = 0.539, P < 0.001), or percentage of international normalized ratio measurements within range (rho = 0.416, P < 0.001). There were significant correlations between patients' educational level and total questionnaire score (rho = 0.357, P = 0.001). No significant correlations were found between income or living area and total questionnaire score (rho = 0.110, P = 0.435; rho = 0.161, P = 0.149). Conclusion Patient knowledge level of anticoagulation therapy affects anticoagulation control. Education for patients new to warfarin and the evaluation of knowledge by validated questionnaire is recommended for better INR control.

Assessment of patient knowledge on warfarin: An item response theory approach.

There are no instruments to assess the patient's knowledge of oral anticoagulation with warfarin, in which the performance of the items has been evaluated through the item response theory. To evaluate psychometric properties of the Brazilian version of the Oral Anticoagulation Knowledge Test, using the item response theory. This methodological study was developed in an anticoagulation clinic of a university hospital with a sample of 201 patients treated with warfarin. The item response theory was used to evaluate questions regarding psychometric properties and the performance of the Brazilian version of the Oral Anticoagulation Knowledge Test items. The unidimensionality hypothesis was analysed by decomposing the polychoric correlation and the Cronbach's alpha coefficient. An item characteristic curve of the 20 items of the instrument was made to identify the discrimination power of each item of the performance scale. Correlations were positive and statistically significant among the 20 items, with a Cronbach's alpha coefficient of 0.82. The difficulty parameter ranged from -4.14 to 0.42. The discrimination parameter ranged from 0.41 to 1.89. The items regarding drug-drug/drug-food interactions were able to differentiate knowledge about oral anticoagulation with greater accuracy. This study is the first that uses this methodology to evaluate the knowledge on oral anticoagulation therapy with warfarin. The evaluation using item response theory showed that the Brazilian version of the Oral Anticoagulation Knowledge Test is suitable for assessing the patient's knowledge of oral anticoagulation with warfarin. Thus, our findings confirmed the utility of this instrument and provided an essential point of reference for the structuring of health education activities that ensure the individualization of educational interventions in patients on warfarin.

Evaluation of a program of pharmaceutical counseling for French patients on oral anticoagulant therapy.

Background Oral anticoagulants are widely used for treatment and prevention of thromboembolic diseases. We set up a pharmaceutical counseling program for both direct oral anticoagulant and vitamin K antagonist drugs in our hospital in 2015. Objective Evaluate patient satisfaction and the evolution of their knowledge throughout the pharmaceutical counseling program on anticoagulants and identify knowledge variability factors. Setting Cardiology Inpatient Unit from the University Antoine Béclère Hospital, France. Methods Evaluation was based on data collection of patients surveyed between 2015 and 2018. Inpatients in the cardiology department on oral anticoagulants were eligible.The learning process was designed to enhance patient knowledge and understanding based on 10 cognitive or self-management skills, relating to the optimization of oral anticoagulant therapy management. It consisted in 2 face-to-face interviews during hospitalization and 2 additional phone interviews one and six months after discharge.The median patient score was evaluated at each step of the process as well as the mean score for each item from the global population. A sub-analysis was run on the less well-acquired skills in order to identify risk factors for limited knowledge. The association between those factors and the level of knowledge (score ≥ 7 or < 7) was assessed using Chi square test followed by multivariate analysis. Main outcome measure Patient knowledge of anticoagulation therapy depending on specific factors. Results Of the 880 patients eligible for pharmaceutical counseling, 319 entered the process and 102 completed it.Median knowledge scores were 8/10 and 9/10 after the first and the final interviews respectively with a significant improvement (p = 0.0003).The least well-acquired items at each step were surveillance and under-dosing management. The sub-analysis showed the use of vitamin K antagonist to be linked to an enhanced understanding related to treatment surveillance (p = 0.029). Patients suffering from atrial fibrillation were found to have a worse understanding of under-dosing management (p = 0.013). Finally, patients evaluated the process as helpful and suitable for their conditions. Conclusion Pharmaceutical counseling is appropriate for patients, improving and maintaining knowledge of oral anticoagulants. Our evaluation highlights the need to focus on patient-specific profiles to reach a satisfactory level of knowledge.

The Impact of a Pharmacist-led Warfarin Educational Video in a Saudi Setting.

ABSTRACTContext:Internationally, various warfarin education strategies have been described in the medical literature and delivered by a variety of health-care providers. However, none of these were tested in a Saudi setting.Aim:The aim of this study was to assess the impact of pharmacist interventions via an educational video on improving patient knowledge of and satisfaction with warfarin therapy and the international normalized ratio (INR).Setting and Design:This study adopted a prospective pre- and posttest design and enrolled 91 patients from an anticoagulant clinic at King Khaled University Hospital in Riyadh, Saudi Arabia, between September 2017 and February 2018.Materials and Methods:All patients completed the Anticoagulation Knowledge Assessment (AKA) and Anti-Clot Treatment Satisfaction (ACTS) scales. Subsequently, the patients watched a 10-min educational video containing basic information regarding warfarin and were given relevant informative booklets. The patients were reassessed after a mean follow-up period of approximately 52 days.Results:In total, 85 patients completed the study. The impact of the intervention on patient knowledge was highly significant (mean difference = 17.7%, 95% confidence interval (CI) = 21.75–13.58, P < 0.000). In addition, the patients showed significant increases in their ACTS benefits subscale scores (mean difference = 0.73, 95% CI = 1.22–0.24, P = 0.004). Despite being long-term warfarin users, the patients’ INRs had a greater tendency to be within the target range after the intervention (56.63% ± 35% vs. 64.72% ± 35% of the time; mean difference, 8.1 percentage points; effect size = 0.23). However, there was no significant effect on patients’ perceptions of the warfarin burden.Conclusion:This study provided evidence that a pharmacist-led audiovisual intervention via an educational video coupled with an informational booklet effectively improved patients’ knowledge retention and satisfaction with warfarin therapy benefits. Longer studies are needed to determine the impact of this intervention on patients’ perceptions of warfarin burdens and their INRs.

Improving Knowledge of Novel Oral Anticoagulants amongst General Dental Practitioners

Introduction Novel Oral Anticoagulants (NOACs) are now being frequently used as an alternative to Warfarin in patients requiring anticoagulation. A considerable number of patients are being referred to the Oral and Maxillofacial surgery department at the RFH London hospitals for simple oral surgery procedures due to the patient's use of NOACs. Some of these procedures could be carried out in primary care. Our aim is to improve the knowledge of NOACs amongst general dental practitioners (GDPs), to allow them to effectively treat this cohort of patients and ultimately reduce the number of referrals to tertiary care, for otherwise simple extractions.

Survey of confidence in use of stroke and bleeding risk calculators, knowledge of anticoagulants, and comfort with prescription of anticoagulation in challenging scenarios: SUPPORT-AF II study.

Half of patients with atrial fibrillation (AF) and elevated stroke risk do not receive anticoagulation (AC). Explanations for undertreatment may relate to provider lack of confidence with or knowledge of the CHA2DS2-VASc stroke calculator, unfamiliarity with direct oral anticoagulants (DOACs), or uncertainty about use of AC after bleeding events or other challenging patient scenarios. We surveyed cardiology and primary care providers (PCPs) within a large healthcare system to investigate prescriber knowledge, confidence, and comfort prescribing AC for AF in challenging scenarios. Of 112 providers invited, 70 (63%) completed our survey. Compared with non-responding providers, responding providers had fewer years in practice and more often worked in a university setting. Responding providers were moderately or very confident with use of CHA2DS2-VASc calculator (90%). Cardiology providers reported substantial knowledge about DOACs (72%) compared with PCPs (33%). Both provider groups reported reluctance prescribing AC when presented with challenging patient scenarios (% providers agreeing with AC): three falls over 6months (36%), 2weeks after resolved gastrointestinal bleed (21%), 4weeks after intracranial bleeding (9%), in a patient consuming five alcoholic drinks per day (44%). All providers were moderately or very confident with using the CHA2DS2-VASc calculator, but only cardiology providers reported substantial knowledge about DOACs. Our providers were reluctant to prescribe AC after bleeding and in other common situations where use of AC may be appropriate. Education of PCPs about DOACs and development of guidelines to address challenging patient scenarios may improve AC prescription rates in patients with AF.

AB139. 204. Surgeons’ and anaesthetists’ knowledge of direct oral anti-coagulants in trauma

AB139. 204. Surgeons’ and anaesthetists’ knowledge of direct oral anti-coagulants in trauma

Supplying Pharmacist Home Visit and Anticoagulation Professional Consultation During Transition of Care for Patients With Venous Thromboembolism.

The aim of the study was to assess the feasibility, satisfaction, and effectiveness of a care transition intervention with pharmacist home visit and subsequent anticoagulation expert consultation for patients with new episode of venous thromboembolism within a not-for-profit health care network. We randomized patients to the intervention or control. During the home visit, a clinical pharmacist assessed medication management proficiency, asked open-ended questions to discuss knowledge gaps, and distributed illustrated medication instructions. Subsequent consultation with anticoagulation expert further filled knowledge gaps. At 30 days, we assessed satisfaction with the intervention and also measured the quality of care transition, knowledge of anticoagulation and venous thromboembolism, and anticoagulant beliefs (level of agreement that anticoagulant is beneficial, is worrisome, and is confusing/difficult to take). The mean ± SD time required to conduct home visits was 52.4 ± 20.5 minutes and most patients agreed that the intervention was helpful. In general, patients reported a high-quality care transition including having been advised of safety issues related to medications. Despite that, the mean percentage of knowledge items answered correctly among patients was low (51.5 versus 50.7 for intervention and controls, respectively). We did not find any significant difference between intervention and control patients for care transition quality, knowledge, or anticoagulant beliefs. We executed a multicomponent intervention that was feasible and rated highly. Nevertheless, the intervention did not improve care transition quality, knowledge, or beliefs. Future research should examine whether alternate strategies potentially including some but not all components of our intervention would be more impactful.

Assessment of Outpatients' Knowledge and Adherence on Warfarin: The Impact of a Simple Educational Pamphlet.

Warfarin is a critical medication that is broadly used for the treatment and prevention of thromboembolic disorders. Due to warfarin’s narrow therapeutic index, it is crucial that patients follow an appropriate dosage regimen. Patient knowledge is one of the most important factors to safe and effective use of warfarin. Due to the obvious risks of anticoagulants administration, evaluating patients’ awareness seems to be crucial. The purpose of this article was to evaluate the effects of intervention by an informative pamphlet on knowledge and adherence of patients who consumed warfarin. Two-hundred and fifty patients receiving warfarin were assigned to the study. They were asked to fill in the questionnaire. Then patients were provided with an educational pamphlet. In the second interview, patients filled the questionnaire again. Obtained data were assessed and analyzed by Excel software and SPSS version 18.0. Out of 250 patients who entered the study, 150 patients attended for the second interview. Data analysis revealed that out of 13 explanatory factors, only patients’ literacy level and income were the predictors which inversely correlated with the patients’ adherence (r = -0.44; p = 0.00040). Our educational intervention had a positive impact on patients’ knowledge regarding anticoagulation (p < 0.0001). Our findings revealed that a written informative pamphlet could effectively increase patients’ anticoagulation knowledge. Since, poorly literate patients had a lesser level of knowledge before and after educational intervention, it is recommended to develop appropriate educational programs especially designed for this group of patients.