Abstract:
BACKGROUND:Anticoagulated patients are often seen unnecessarily in the emergency department (ED) for epistaxis, leading to increased healthcare costs. Patients are often unaware of preventative and management techniques for handling epistaxis in the home. METHODS:In 2016, the Michigan Anticoagulation Quality Improvement Initiative (MAQI2), a Blue Cross Blue Shield of Michigan-sponsored consortium of 6 anticoagulation clinics in Michigan, implemented an epistaxis-management educational program for warfarin-treated patients with the goal of reducing unnecessary ED visits. A pre-implementation cohort (2014-2015) consisted of patients who did not receive epistaxis-related educational materials. A post-implementation cohort (2017-2018) received epistaxis educational materials covering home treatment and prevention strategies. Patient characteristics and outcomes (rates of epistaxis and epistaxis ED visits) were compared using Chi-square, Poisson regression, and t-tests. RESULTS:Of the 4473 patients included, 2634 (58.9%) initiated warfarin in the pre-implementation phase and 1839 (41.1%) initiated warfarin in the post-implementation phase. The post-implementation cohort had a lower overall epistaxis rate (13.4 vs 10.4 per 100 patient-year, pre- vs. post-implementation; p = 0.029), a lower epistaxis-related ED visit rate (5.6 vs. 3.1 per 100 patient-year; p = 0.003), and a lower proportion of nosebleeds that led to an ED visit (42% vs. 30%; p = 0.032). After controlling for antiplatelet use, renal disease, and time in therapeutic range, both cohorts were equally likely to have nosebleeds (RR 0.77, 95% CI: 0.58-1.02); however, the post-implementation cohort was less likely to visit the ED for epistaxis (RR 0.52, 95% CI: 0.32-0.84). CONCLUSION:An epistaxis education program was associated with a reduction in epistaxis-related ED visits among warfarin-treated patients.
journal_name
Thromb Resjournal_title
Thrombosis researchauthors
Neshewat J,Wasserman A,Alexandris-Souphis C,Haymart B,Feldeisen D,Kong X,Harvey RS,Pynnonen M,Froehlich JB,Kline-Rogers E,Barnes GDdoi
10.1016/j.thromres.2021.01.007subject
Has Abstractpub_date
2021-01-16 00:00:00pages
119-122eissn
0049-3848issn
1879-2472pii
S0049-3848(21)00016-5journal_volume
199pub_type
信件abstract:INTRODUCTION:Cancer is a major risk factor for developing venous thromboembolism (VTE). Plasma hypercoagulability is an established risk factor for cancer-related VTE. In addition, thrombocytosis and hyperreactive platelets have been implicated in VTE and cancer progression. Cirrhosis is associated with changes in plat...
journal_title:Thrombosis research
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abstract::Chronic immune thrombocytopenia purpura (ITP) is an autoimmune disease that exhibits an abnormally high Th1/Th2 ratio. Granulocyte colony-stimulating factor (G-CSF) has been shown to decrease the Th1/Th2 ratio in healthy donors. In this study, we investigated the effects of G-CSF treatment on the Th1/Th2 cells and the...
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abstract::It has been suggested that unstable angina at rest, like acute myocardial infarction, might be associated with a thrombotic process. In order to study the hypothesis that myocardial ischemia during exercise could also be associated with an activation of blood coagulation and/or fibrinolysis, we investigated the presen...
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doi:10.1016/0049-3848(92)90222-v
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abstract::We purified the urinary procoagulant from frozen human urine by introducing phenyl-Sepharose hydrophobic chromatography. By this method, the apoprotein of the procoagulant and the lipid-like substance were separately recovered. Upon reassociation with the lipid-like substance or exogenous crude phospholipids, the apop...
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abstract::The fibrinolytic potential of tissue-type plasminogen activator (t-PA) either incorporated in a clot (endogenous) or added to the surrounding plasma (exogenous), was studied in an in vitro system consisting of 125I-labeled human plasma clots (200 microliters) immersed in human plasma (2 ml). Clot lysis was measured as...
journal_title:Thrombosis research
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abstract::Although effective therapies for haemophilia have been available for decades, the prevention and treatment of joint disease remain major clinical concerns for all haemophilia patients. Early identification of joint disease is vital to initiate or modify treatment, and prevent arthropathy. However, there remains a need...
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abstract:BACKGROUND:Early aspirin treatment is widely used to inhibit platelet activity and to reduce morbidity and mortality in patients presenting with an acute myocardial infarction or a stroke. A number of different aspirin formulations have been used for this purpose; however, a comparison of their effectiveness in inhibit...
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journal_title:Thrombosis research
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更新日期:2015-03-01 00:00:00
abstract:OBJECTIVES:To evaluate the role of filter implantation in reducing the incidence of fatal pulmonary embolism during the endovascular treatment of thrombosis in the major tributary of the superior vena cava (SVC). METHODS:From October 2004 to October 2008, we conducted a cohort study of 40 patients with thrombosis of t...
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journal_title:Thrombosis research
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doi:10.1016/j.thromres.2008.06.020
更新日期:2008-01-01 00:00:00
abstract::COVID-19 has been associated with an increased risk of thrombotic events; however, the reported incidence of deep vein thrombosis varies depending, at least in part, on the severity of the disease. Aim of this prospective, multicenter, observational study was to investigate the incidence of lower limb deep vein thromb...
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pub_type: 杂志文章,多中心研究
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abstract::Several sex-related differences in the incidence rate, clinical presentation and outcomes of VTE were recently investigated. Gender-related risk factors, such as the use of oral contraceptives (OC) and pregnancy, in particular in women with a thrombophilic state, are associated with an increased risk of venous thrombo...
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abstract::Forty women undergoing surgery under general anaesthesia for hyperplasia mammae were randomized to treatment with low dose heparin (5000 IU twice daily) or not. Preoperatively, and repeated on the 3. postoperative day, assays of euglobulin clot lysis time (ELT) after venous stasis, tissue plasminogen activator (t-PA) ...
journal_title:Thrombosis research
pub_type: 临床试验,杂志文章,随机对照试验
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pub_type: 杂志文章,随机对照试验
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abstract::Advances in antithrombotic therapy began when traditional anticoagulant agents such as heparin and the vitamin K antagonists like Coumadin became commercially available in the 1940s and 1950s. Inherent limitations of these compounds, including the need for monitoring and multiple food and drug interactions (with couma...
journal_title:Thrombosis research
pub_type: 杂志文章,评审
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journal_title:Thrombosis research
pub_type: 杂志文章
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abstract::The time course and degree of collagen induced platelet shape change, aggregation and ATP-secretion in citrated human platelet rich plasma was monitored with a lumi-aggregometer. Onset of ATP-secretion was measurable within seconds after collagen challenge and always distinctly before onset of shape change. In absence...
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