Adherencia al tratamiento anticoagulante: Hospital de San José. Bogotá DC, Colombia
Adherence to anticoagulant treatment: Hospital de San José. Bogotá DC, Colombia
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Solano, M. H., & Mendieta, F. A. (2014). Adherencia al tratamiento anticoagulante: Hospital de San José. Bogotá DC, Colombia. Revista Repertorio De Medicina Y Cirugía, 23(3), 189–198. https://doi.org/10.31260/RepertMedCir.v23.n3.2014.708
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La anticoagulación requiere monitoreo continuo por el alto riesgo de complicaciones trombóticas y hemorrágicas. El éxito depende en gran medida de la educación del paciente para una adecuada adherencia terapéutica. Objetivo: evaluar esta adherencia en la clínica de anticoagulación del servicio de hematología del Hospital de San José de Bogotá DC (Colombia) durante un período de tres meses. Metodología: estudio descriptivo de corte transversal en el cual se aplicó la escala ARMS. La puntuación total osciló entre 12 y 48, siendo 12 el nivel perfecto y 48 el peor. Resultados: se aplicó el cuestionario a 106 pacientes. En la evaluación global la puntuación estuvo entre 12 y 26 (promedio: 13.72, DS: 2.19), en la subescala sobre la toma del anticoagulante, entre 8 y 19 (promedio: 9.12, DS: 1.58) y en la subescala según la disponibilidad del medicamento entre 4 y 8 (promedio: 4.60, DS: 1.00). La mejor adherencia se identificó en el ítem 5 (promedio: 1.01, DS: 0.13) y la peor en el ítem 1 (promedio: 1.39, DS: 0.56). El 35% (n= 37) obtuvo una adherencia perfecta. Conclusiones: la adherencia terapéutica global es buena, pero se identificaron barreras relacionadas con el paciente y el suministro del anticoagulante, que justifican el fortalecimiento de la educación al paciente y el desarrollo de estrategias para la entrega oportuna del medicamento.
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2. Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med. 1998;158(15):1641-7.
3. Gray DR, Garabedian-Ruffalo SM, Chretien SD. Cost-justification of a clinical pharmacist-managed anticoagulation clinic. Ann Pharmacother. 2007;41(3):496-501.
4. Aziz F, Corder M, Wolffe J, Comerota AJ. Anticoagulation monitoring by an anticoagulation service is more cost-effective than routine physician care. J Vasc Surg. 2011;54(5):1404-7.
5. Fitzmaurice DA, Hobbs FD, Murray ET, Holder RL, Allan TF, Rose PE. Oral anticoagulation management in primary care with the use of computerized decision support and near-patient testing: a randomized, controlled trial. Arch Intern Med. 2000;160(15):2343-8.
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7. Berrettini M. Anticoagulation clinics: the Italian experience. Haematologica. 1997;82(6):713-7.
8. Van Walraven C, Jennings A, Oake N, Fergusson D, Forster AJ. Effect of study setting on anticoagulation control: a systematic review and metaregression. Chest. 2006;129(5):1155-66.
9. Rand CS. Measuring adherence with therapy for chronic diseases: implications for the treatment of heterozygous familial hypercholesterolemia. Am J Cardiol. 1993;72(10):68D-74D.
10. Timmreck TC, Randolph JF. Smoking cessation: clinical steps to improve compliance. Geriatrics. 1993;48(4):63-6, 9-70.
11. Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther. 1999;21(6):1074-90.
12. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74.
13. Sumartojo E. When tuberculosis treatment fails. A social behavioral account of patient adherence. Am Rev Respir Dis. 1993;147(5):1311-20.
14. Matsui D, Hermann C, Klein J, Berkovitch M, Olivieri N, Koren G. Critical comparison of novel and existing methods of compliance assesment during a clinical trial of an oral iron chelator. J Clin Pharmacol. 1994;34(9):944-9.
15. Platt AB, Localio AR, Brensinger CM, Cruess DG, Christie JD, Gross R, et al. Can We Predict Daily Adherence to Warfarin? Chest. 2010;137(4):883-9.
16. Vitolins MZ RC, Rapp SR, Ribisi PM, Sevick MA. Measuring adherence to behavioral and medical interventions. Control Clin Trials. 2000;21(5):188S-94S.
17. Kripalani S RJ, Gatti ME, Jacobson TA. Development and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic disease. Value Health. 2009;12(1):118-23.
18. Mateo J, Oliver A, Borrell M, Sala N, Fontcuberta J. Laboratory evaluation and clinical characteristics of 2,132 consecutive unselected patients with venous thromboembolism--results of the Spanish Multicentric Study on Thrombophilia (EMET-Study). Thromb Haemost. 1997;77(3):444-51.
19. Lefrere JJ, Guyon F, Horellou MH, Conard J, Samama M. [Resistance to vitamin K antagonists. 6 cases]. Ann Med Interne (Paris). 1986;137(5):384-90.
20. Hallak HO, Wedlund PJ, Modi MW, Patel IH, Lewis GL, Woodruff B, et al. High clearance of (S)-warfarin in a warfarin-resistant subject. Br J Clin Pharmacol. 1993;35(3):327-30.
21. Hulse ML. Warfarin resistance: diagnosis and therapeutic alternatives. Pharmacotherapy. 1996;16(6):1009-17.
22. Limdi NA, Limdi MA, Cavallari L, Anderson AM, Crowley MR, Baird MF, et al. Warfarin dosing in patients with impaired kidney function. Am J Kidney Dis. 2010;56(5):823-31.
23. Wysowski DK, Nourjah P, Swartz L. Bleeding complications with warfarin use: a prevalent adverse effect resulting in regulatory action. Arch Intern Med. 2007;167(13):1414-9.
24. Delaney JA, Opatrny L, Brophy JM, Suissa S. Drug drug interactions between antithrombotic medications and the risk of gastrointestinal bleeding. CMAJ. 2007;177(4):347-51.
25. Schelleman H, Bilker WB, Brensinger CM, Wan F, Yang YX, Hennessy S. Fibrate/Statin initiation in warfarin users and gastrointestinal bleeding risk. Am J Med. 2010;123(2):151-7.
26. Limdi NA, Beasley TM, Baird MF, Goldstein JA, McGwin G, Arnett DK, et al. Kidney function influences warfarin responsiveness and hemorrhagic complications. J Am Soc Nephrol. 2009;20(4):912-21.
27. Wells PS, Forgie MA, Simms M, Greene A, Touchie D, Lewis G, et al. The outpatient bleeding risk index: validation of a tool for predicting bleeding rates in patients treated for deep venous thrombosis and pulmonary embolism. Arch Intern Med. 2003;163(8):917-20.
28. Gage BF, Yan Y, Milligan PE, Waterman AD, Culverhouse R, Rich MW, et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J. 2006;151(3):713-9.
29. Anand S, Yusuf S, Xie C, Pogue J, Eikelboom J, Budaj A, et al. Oral anticoagulant and antiplatelet therapy and peripheral arterial disease. N Engl J Med.2007;357(3):217-27.
30. Ruiz-Giménez N, Suárez C, González R, Nieto JA, Todoli JA, Samperiz AL, et al. Predictive variables for major bleeding events in patients presenting with documented acute venous thromboembolism. Findings from the RIETE Registry. Thromb Haemost. 2008;100(1):26-31.
31. Nieto JA, Solano R, Ruiz-Ribo MD, Ruiz-Gimenez N, Prandoni P, Kearon C, et al. Fatal bleeding in patients receiving anticoagulant therapy for venous thromboembolism: findings from the RIETE registry. J Thromb Haemost. 2010 Jun; 8(6):1216-22.
32. Zhao HJ, Zheng ZT, Wang ZH, Li SH, Zhang Y, Zhong M, et al. “Triple therapy” rather than “triple threat”: a meta-analysis of the two antithrombotic regimens after stent implantation in patients receiving long-term oral anticoagulant treatment. Chest. 2011;139(2):260-70.
2. Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med. 1998;158(15):1641-7.
3. Gray DR, Garabedian-Ruffalo SM, Chretien SD. Cost-justification of a clinical pharmacist-managed anticoagulation clinic. Ann Pharmacother. 2007;41(3):496-501.
4. Aziz F, Corder M, Wolffe J, Comerota AJ. Anticoagulation monitoring by an anticoagulation service is more cost-effective than routine physician care. J Vasc Surg. 2011;54(5):1404-7.
5. Fitzmaurice DA, Hobbs FD, Murray ET, Holder RL, Allan TF, Rose PE. Oral anticoagulation management in primary care with the use of computerized decision support and near-patient testing: a randomized, controlled trial. Arch Intern Med. 2000;160(15):2343-8.
6. Wittkowsky AK, Nutescu EA, Blackburn J, Mullins J, Hardman J, Mitchell J, et al. Outcomes of oral anticoagulant therapy managed by telephone vs in-office visits in an anticoagulation clinic setting. Chest. 2006;130(5):1385-9.
7. Berrettini M. Anticoagulation clinics: the Italian experience. Haematologica. 1997;82(6):713-7.
8. Van Walraven C, Jennings A, Oake N, Fergusson D, Forster AJ. Effect of study setting on anticoagulation control: a systematic review and metaregression. Chest. 2006;129(5):1155-66.
9. Rand CS. Measuring adherence with therapy for chronic diseases: implications for the treatment of heterozygous familial hypercholesterolemia. Am J Cardiol. 1993;72(10):68D-74D.
10. Timmreck TC, Randolph JF. Smoking cessation: clinical steps to improve compliance. Geriatrics. 1993;48(4):63-6, 9-70.
11. Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther. 1999;21(6):1074-90.
12. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74.
13. Sumartojo E. When tuberculosis treatment fails. A social behavioral account of patient adherence. Am Rev Respir Dis. 1993;147(5):1311-20.
14. Matsui D, Hermann C, Klein J, Berkovitch M, Olivieri N, Koren G. Critical comparison of novel and existing methods of compliance assesment during a clinical trial of an oral iron chelator. J Clin Pharmacol. 1994;34(9):944-9.
15. Platt AB, Localio AR, Brensinger CM, Cruess DG, Christie JD, Gross R, et al. Can We Predict Daily Adherence to Warfarin? Chest. 2010;137(4):883-9.
16. Vitolins MZ RC, Rapp SR, Ribisi PM, Sevick MA. Measuring adherence to behavioral and medical interventions. Control Clin Trials. 2000;21(5):188S-94S.
17. Kripalani S RJ, Gatti ME, Jacobson TA. Development and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic disease. Value Health. 2009;12(1):118-23.
18. Mateo J, Oliver A, Borrell M, Sala N, Fontcuberta J. Laboratory evaluation and clinical characteristics of 2,132 consecutive unselected patients with venous thromboembolism--results of the Spanish Multicentric Study on Thrombophilia (EMET-Study). Thromb Haemost. 1997;77(3):444-51.
19. Lefrere JJ, Guyon F, Horellou MH, Conard J, Samama M. [Resistance to vitamin K antagonists. 6 cases]. Ann Med Interne (Paris). 1986;137(5):384-90.
20. Hallak HO, Wedlund PJ, Modi MW, Patel IH, Lewis GL, Woodruff B, et al. High clearance of (S)-warfarin in a warfarin-resistant subject. Br J Clin Pharmacol. 1993;35(3):327-30.
21. Hulse ML. Warfarin resistance: diagnosis and therapeutic alternatives. Pharmacotherapy. 1996;16(6):1009-17.
22. Limdi NA, Limdi MA, Cavallari L, Anderson AM, Crowley MR, Baird MF, et al. Warfarin dosing in patients with impaired kidney function. Am J Kidney Dis. 2010;56(5):823-31.
23. Wysowski DK, Nourjah P, Swartz L. Bleeding complications with warfarin use: a prevalent adverse effect resulting in regulatory action. Arch Intern Med. 2007;167(13):1414-9.
24. Delaney JA, Opatrny L, Brophy JM, Suissa S. Drug drug interactions between antithrombotic medications and the risk of gastrointestinal bleeding. CMAJ. 2007;177(4):347-51.
25. Schelleman H, Bilker WB, Brensinger CM, Wan F, Yang YX, Hennessy S. Fibrate/Statin initiation in warfarin users and gastrointestinal bleeding risk. Am J Med. 2010;123(2):151-7.
26. Limdi NA, Beasley TM, Baird MF, Goldstein JA, McGwin G, Arnett DK, et al. Kidney function influences warfarin responsiveness and hemorrhagic complications. J Am Soc Nephrol. 2009;20(4):912-21.
27. Wells PS, Forgie MA, Simms M, Greene A, Touchie D, Lewis G, et al. The outpatient bleeding risk index: validation of a tool for predicting bleeding rates in patients treated for deep venous thrombosis and pulmonary embolism. Arch Intern Med. 2003;163(8):917-20.
28. Gage BF, Yan Y, Milligan PE, Waterman AD, Culverhouse R, Rich MW, et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J. 2006;151(3):713-9.
29. Anand S, Yusuf S, Xie C, Pogue J, Eikelboom J, Budaj A, et al. Oral anticoagulant and antiplatelet therapy and peripheral arterial disease. N Engl J Med.2007;357(3):217-27.
30. Ruiz-Giménez N, Suárez C, González R, Nieto JA, Todoli JA, Samperiz AL, et al. Predictive variables for major bleeding events in patients presenting with documented acute venous thromboembolism. Findings from the RIETE Registry. Thromb Haemost. 2008;100(1):26-31.
31. Nieto JA, Solano R, Ruiz-Ribo MD, Ruiz-Gimenez N, Prandoni P, Kearon C, et al. Fatal bleeding in patients receiving anticoagulant therapy for venous thromboembolism: findings from the RIETE registry. J Thromb Haemost. 2010 Jun; 8(6):1216-22.
32. Zhao HJ, Zheng ZT, Wang ZH, Li SH, Zhang Y, Zhong M, et al. “Triple therapy” rather than “triple threat”: a meta-analysis of the two antithrombotic regimens after stent implantation in patients receiving long-term oral anticoagulant treatment. Chest. 2011;139(2):260-70.
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