Abstract:
:Background The efficacy and safety of direct oral anticoagulants is well established in patients with atrial fibrillation. However, data on their use in the oldest old patients (≥ 85 years), who have the highest risk of bleeding, is scarce. Objective The aim of this study was to evaluate the safety of direct oral anticoagulants in the oldest old patients with atrial fibrillation and assess the impact of age on major bleeding events. Setting Anticoagulation Clinic of the Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia. Methods From our single-centre prospective registry we enrolled 2260 consecutive atrial fibrillation patients aged ≥ 65 years that were started on dabigatran, rivaroxaban or apixaban. The mean duration of treatment exposure was 735 days. The primary outcome was the incidence of major bleeding. The incidence of thromboembolic events and death were also assessed. Potential risk factors for major bleeding were evaluated using Cox regression analysis. Main outcome measure Rate of major bleeding. Results During the follow-up 106 patients experienced major bleeding (2.3%/year). The oldest old patients (≥ 85 years) had the highest risk of any major bleeding (HR 2.50, 95% CI 1.44-4.32, p = 0.001), intracranial bleeding (HR 4.74, 95% CI 1.48-15.14, p < 0.01) and major gastrointestinal bleeding (HR 2.32, 95% CI 1.10-4.89, p < 0.03) compared to the group of patients aged 65-74 years, even though the majority of them were treated with reduced doses of direct oral anticoagulants. Significant predictors for major bleeding were age group ≥ 85 years (HR 2.52, 95% CI 1.43-4.47, p = 0.001) and history of bleeding (HR 3.32, 95% CI 1.87-5.90, p < 0.001). The incidence of a composite of stroke, transient ischemic attack and systemic embolism was 1.3%/year. Conclusion In this prospective real-world clinical study we have shown that the oldest old patients have the highest risk of major bleeding, which is further increased with a patient's history of bleeding.
journal_name
Int J Clin Pharmjournal_title
International journal of clinical pharmacyauthors
Šinigoj P,Vene N,Košmelj K,Mavri Adoi
10.1007/s11096-020-01008-1subject
Has Abstractpub_date
2020-04-01 00:00:00pages
445-452issue
2eissn
2210-7703issn
2210-7711pii
10.1007/s11096-020-01008-1journal_volume
42pub_type
杂志文章abstract::Background Patients' potential misconceptions and concerns about using opioids are among the primary causes of patient-related barriers that may lead to failure in pain management. These barriers can be eliminated through educational interventions, thus achieving better pain management. Objective The aim of this study...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-020-01098-x
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Bleeding complications have been frequently reported in East Asian patients on warfarin with a target international normalized ratio (INR) of 2.0-3.0. OBJECTIVE:This study aimed to identify the optimal therapeutic range of the INR in Korean patients with non-valvular atrial fibrillation (NVAF). Setting Card...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-015-0149-5
更新日期:2015-12-01 00:00:00
abstract::Background Modern antiviral treatments have high cure rates against the hepatitis C virus however, the high cost associated with branded medicines and diagnostic tests, have resulted in poor access for many low-income patients residing in low-and-middle-income countries. Objective This study aimed to evaluate the role...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-020-01202-1
更新日期:2020-11-28 00:00:00
abstract:BACKGROUND:Ethnic diversity is increasingly encountered in the HIV-infected population in North America, and it is unknown if beliefs surrounding illness and treatment vary among different ethnic groups. OBJECTIVE:Our objectives were to determine whether self-reported adherence, illness perceptions and treatment belie...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-013-9866-9
更新日期:2014-02-01 00:00:00
abstract::Background Population-based studies investigating indications for antidepressant prescribing mostly rely on diagnoses from general practitioners. However, diagnostic codes might be incomplete and drugs may be prescribed 'off-label' for indications not investigated in clinical trials. Objective We aimed to study indica...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-016-0371-9
更新日期:2016-10-01 00:00:00
abstract:BACKGROUND:Medication discrepancies may occur at transitions in care and negatively impact patient outcomes. OBJECTIVE:To determine if involving clinical pharmacists in hospital care, medication reconciliation and discharge medication plan communication can reduce medication discrepancies with a prospective, randomize...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-014-9917-x
更新日期:2014-04-01 00:00:00
abstract::Background Pharmacists' involvement in patient care has improved the quality of care and reduced medication errors. However, this has required a lot of work that could not have been accomplished without documentation of interventions. Several means of documenting errors have been proposed in the literature but without...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-016-0384-4
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:The well-being of patients with Parkinson's disease may be improved by pharmaceutical care in community pharmacies. OBJECTIVE:To investigate the effects of standardised pharmaceutical care on health outcomes and quality of drug treatment in patients with Parkinson's disease. SETTING:Community pharmacies in...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章,多中心研究
doi:10.1007/s11096-012-9672-9
更新日期:2012-10-01 00:00:00
abstract::Bridging the gap between hospital and primary care is important as transition from one healthcare setting to another increases the risk on drug-related problems and consequent readmissions. To reduce those risks, pharmacist interventions during and after hospitalization have been frequently studied, albeit with variab...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-015-0093-4
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:The prevalence of diabetes in Jordan is among the highest in the world, making it a particularly alarming health problem there. It has been indicated that poor adherence to the prescribed therapy lead to poor glycemic control and enhance the development of diabetes complications and unnecessary hospitalizati...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-014-9938-5
更新日期:2014-08-01 00:00:00
abstract::Background Rheumatoid arthritis is a chronic, autoimmune disease in which treatment has evolved with a variety of therapeutic classes. Biological disease-modifying antirheumatic drugs have improved therapy; however, the continued long-term use of these drugs with sustained safety and efficacy remains a challenge. Obje...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-020-01171-5
更新日期:2020-10-21 00:00:00
abstract::Background The inclusion of pharmacist in health care system is essential to ensure optimal patient care. However, with the passage of time, pharmacist's role has transcended from dispensing, compounding and counting of pills, to more sophisticated clinical duties. Objective To evaluate doctors' experience, perception...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-020-00991-9
更新日期:2020-04-01 00:00:00
abstract::Background Due to recent EU warnings and restrictions on the combined use of renin-angiotensin-aldosterone system (RAAS)-acting agents, and the seriousness of the associated harm, we analyzed the prescription of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) as dual therapy o...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-016-0378-2
更新日期:2016-12-01 00:00:00
abstract:CASE:We report a 32-year old relapse case of Visceral leishmaniasis, treated with Paromomycin who belonged from a endemic zone of Bihar state, India. After confirmation, he was treated with Amphotericin B, followed by Liposomal Amphotericin B in full course and even in higher dose. But after each therapy, the patient e...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-011-9544-8
更新日期:2011-10-01 00:00:00
abstract::Background Studies in international literature have shown that Community Pharmacists can make considerable impact in controlling cardiovascular disease risk factors, especially hypertension. In Nigeria, there are no studies on the knowledge of CVD risk factors by Community Pharmacists and their practice of primary pre...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-018-0744-3
更新日期:2018-12-01 00:00:00
abstract::Background Medication adherence is a multifaceted issue that is influenced by various factors. One factor may be the concurrent use of over-the-counter (OTC) medicines. The use of OTC medicine has been reported as common amongst elderly patients. Objective To determine if a correlation exists between the use of OTC me...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-013-9863-z
更新日期:2013-10-12 00:00:00
abstract::Background Implementation of clinical medication reviews in daily practice is scarcely evaluated. The Opti-Med intervention applied a structured approach with external expert teams (pharmacist and physician) to conduct medication reviews. The intervention was effective with respect to resolving drug related problems, ...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-018-0615-y
更新日期:2018-06-01 00:00:00
abstract::Background Community pharmacists' role in the primary health care, patient-centered services, beyond traditional dispensing services is well established in the developed world. However, this role is not fully established in low-middle-income countries including Pakistan. Objective To explore community pharmacists' per...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-020-01221-y
更新日期:2021-01-07 00:00:00
abstract:BACKGROUND:Ocular allergies frequently present in pharmacy practices. However, research into the actual management of ocular allergy in pharmacies is lacking. OBJECTIVE:To determine and quantify history and symptom questioning of a patient with presumed allergic conjunctivitis and management strategies employed by pha...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-012-9742-z
更新日期:2013-04-01 00:00:00
abstract::Background Half of Americans experience mental illness during their lifetime. Significant opportunity exists for community pharmacists to deliver services to these patients; however, personal and practice-related barriers may prevent full engagement. Objective To assess the demographics, practice characteristics, serv...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-018-0619-7
更新日期:2018-10-01 00:00:00
abstract::Background After radical cystectomy, delayed return of bowel function is relatively common. Although studies investigating on the best modality for delivering nutritional support to this patient group are limited, parenteral nutrition was standard of care in those patients at the urological ward of the University Hosp...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-019-00800-y
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:There can be a lack of transfer of information between hospitals and community pharmacies following patient discharge, which puts patients at a high risk of suffering drug related problems (DRPs). Community pharmacy plays a vital role in identifying and solving these discharge DRPs and taking action before t...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-014-9935-8
更新日期:2014-06-01 00:00:00
abstract::Background Tyrosine kinase inhibitors have been demonstrated to improve the survival of patients with chronic myeloid leukaemia. However, medication adherence is vital for patients on chronic treatment. Objective The objective of the current study was to evaluate response to treatment, adherence by patients to tyrosin...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-020-01070-9
更新日期:2020-06-11 00:00:00
abstract::Background Little is known with regards to the prognostic factors for patients with suspected or diagnosed Heparin-Induced Thromobocytopenia (HIT). The role of patient and therapy characteristics may play a role in predicting the outcome. Aim of the review To investigate the role of patient and therapy characteristic...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章,评审
doi:10.1007/s11096-020-01166-2
更新日期:2020-10-12 00:00:00
abstract:BACKGROUND:Older patients receiving home health care are particularly at risk of receiving potentially inappropriate medications compared to community-dwelling population. Data on appropriateness of prescribing in these patients is limited. OBJECTIVE:To investigate the prevalence, patterns and determinants of potentia...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-015-0125-0
更新日期:2015-10-01 00:00:00
abstract::Background Gram negative pathogens are increasingly resistant to commonly used first line antibiotics and colistin is in most cases the only medicine available. There is very limited information available comparing the effectiveness and costs of low versus high dose colistin with studies showing efficacy with both dos...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-018-0713-x
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:Responsible self-medication is an integral part of the health system that consists of community pharmacists counseling patients on treating minor illness using non-prescription medications. Systems for properly managing information can assist disease identification and clinical decision-making. OBJECTIVE:To...
journal_title:International journal of clinical pharmacy
pub_type: 共识发展会议,杂志文章
doi:10.1007/s11096-015-0223-z
更新日期:2016-02-01 00:00:00
abstract:BACKGROUND:A quick CYP2C19*2 genotyping assay can be useful in personalised antiplatelet-therapy. OBJECTIVE:To apply a rapid point-of-care (POC) CYP2C19*2 genotyping assay for personalisation of antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI) and to compare this POC assay to two la...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-016-0269-6
更新日期:2016-04-01 00:00:00
abstract::Background Non-adherence to immunosuppressive medications following renal transplantation is a risk factor for rejection and graft loss. Despite the dire consequences, adherence lapses, both unintentional and intentional, are common and poorly understood. Objective The present study sets to compare the rates and deter...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-018-0652-6
更新日期:2018-10-01 00:00:00
abstract::Background Pharmacists are increasingly involved in patient care. This new role in a complex healthcare system with demanding patients may lead to moral dilemmas. There has been little research into pharmacy ethics, and existing data are limited by their retrospective nature and small sample sizes. A thematic overview...
journal_title:International journal of clinical pharmacy
pub_type: 杂志文章
doi:10.1007/s11096-017-0561-0
更新日期:2018-02-01 00:00:00