A Patient’s Voice. John’s* perspective is shared in each section. John is a 75-year-old retired surgeon with atrial fibrillation who has been taking warfarin for 10 years. John also has gout and arthritis and a stent for which he takes baby aspirin. - PowerPoint PPT Presentation
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A Patient’s Voice John’s* perspective is shared in each section. John is a 75-year-old retired surgeon with atrial fibrillation who has been taking warfarin for 10 years. John also has gout and arthritis and a stent for which he takes baby aspirin. When he initially started warfarin, it took about 8 to 12 weeks to stabilize his INR within therapeutic range, mainly through dietary adjustments. For the last 5 years, John has been using a home INR kit every 4 to 6 weeks and submits the results through an automated system to his physician. His INR has remained mostly between 2 and 3 and has never exceeded a low of 1.8 or high of 4.3. John’s atrial fibrillation and anticoagulation therapy *Not the patient’s real name.
Transcript
A Patient’s Voice
John’s* perspective is shared in each section.
John is a 75-year-old retired surgeon with atrial fibrillation who has been taking warfarin for 10 years. John also has gout and arthritis and a stent for which he takes baby aspirin.
When he initially started warfarin, it took about 8 to 12 weeks to stabilize his INR within therapeutic range, mainly through dietary adjustments.
For the last 5 years, John has been using a home INR kit every 4 to 6 weeks and submits the results through an automated system to his physician. His INR has remained mostly between 2 and 3 and has never exceeded a low of 1.8 or high of 4.3.
John’s atrial fibrillation and anticoagulation therapy have not significantly impacted his family or required him to change his lifestyle.
*Not the patient’s real name.
A Patient’s Voice
During atrial fibrillation, a blood clot can form in the left atrium of the heart. If a piece of the clot breaks off and travels to an artery in the brain, it can block blood flow, causinga stroke.
Patients may not be aware of the different types of atrial fibrillation—educate them.
Educate your patients that anticoagulation is critical, but it is just one aspect of managing atrial fibrillation.
Affected portion of the brain
Embolus blocks blood flow to part of the brain
Internal carotid artery
Common carotid artery
Embolus (clot)
Aorta
Atrial fibrillation in the left atrium
Thrombus (clot)
Heart
NHLBI. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/af/signs.html.
Resources and Tools
John’s CHADS2 score is 1 (due to his age).
Empower your patients by educating them on CHADS2.
A Patient’s Voice
Resources and Tools Available at TEAManticoag.com
“It’s so much more important to prevent stroke than to reduce bleeds.”For John, the bleeding concern has been quite benign. As a surgeon, he was more worried about his patients bleeding. He believes his physiological makeup makes him less prone to bruising and bleeding.
A Patient’s Voice
Resources and Tools Available at TEAManticoag.com
Generic/Trade Name Identification Guide for Drugs Mentioned in Activity
*For identification purposes only; does not imply endorsement.
Resources and Tools
Warfarin and Novel Anticoagulant Mechanisms of Action
Courtesy of David Garcia, MD.
XIIXI
IXVIII
X
VII
V
II
I
Fibrin Clot
New Oral Xa InhibitorsRivaroxabanApixabanEdoxaban
New Oral IIa InhibitorDabigatran etexilate
Unfractionated Heparin
Low-Molecular-Weight Heparin Warfarin
Resources and Tools
A Patient’s Voice
John’s physician offered him a new anticoagulant, but John decided to stay with warfarin because it is:
Working for him (it is preventing strokes)
Cost effective (he does at-home INR testing)
Reversible (at his age, he is at greater bleed risk and it is harder to reverse with the newer anticoagulants)
Advice for a new patient who will begin warfarin
“To be successful on warfarin, the patient needs to be reliable.”“Take the medication as directed regularly, modify diet as needed to keep dosage in range, and if able and responsible, get your own INR kit for testing.”
Diet and warfarin “Get the dietary thing squared away up front. Once you are rock solid with the diet, maintaining the medication is a lot easier.”“I love veggies but have reduced leafy vegetables to minimize excess vitamin K to keep INR in range.”
Resources and Tools Available at TEAManticoag.com
A Patient’s Voice
John believes cost is important to discuss with patients, including: Approximate monthly cost of being on warfarin vs newer drugs
Cost of INR testing in office or at home
Practical ways to obtain medication (retail pharmacy vs hospital, mail order, manufacturer’s patient assistance program, etc)
John travels often and lives in 3 different locations each year. He monitors his INR using a home kit. “For someone with reasonable education and background, these kits sure simplify travel time and specimen blood collection and reporting costs.”
John believes reversibility is important to discuss with patients.
John has never had a nosebleed while on warfarin.
Visit the Anticoagulation Forum (acforum.org) to find anticoagulation clinic locations.
Resources and Tools
A Patient’s Voice
Use pamphlets, comic book-like brochures, or new apps to educate patients on strokes and anticoagulation.
John believes the seriousness of a stroke is so important that if patients resist anticoagulation therapy, the physician should have them sign a release (as Dr. Flores suggests).
Patient handout
Resources and Tools Available at TEAManticoag.com
A Patient’s Voice
John has not interrupted anticoagulation for dental procedures, but when John’s stent was placed, he was off warfarin for a couple days and bridged with heparin.
