Thesis (Ph. D.)--University of Wisconsin, 1965. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (Ph. D.)--University of Texas at Austin, 2006. / Vita. Includes bibliographical references.

Thesis (M.S.M.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / OBJECTIVE: Prior studies examining the association of warfarin use and osteoporotic fractures have found conflicting results and have had methodological problems, such as confounding by indication and confounding by duration of warfarin use. Thus, we studied the association of warfarin use with fractures at the hip, spine and wrist, among older men and women with atrial fibrillation recruited from the general population, using rigorous statistical tools to overcome challenges faced by prior studies. METHODS: We included men and women ≥65 years with incident atrial fibrillation, without history of fracture, followed between 2000-2010 from The Health Improvement Network (THIN). Long-term warfarin use was defined in two ways: 1) warfarin use ≥ 1year; 2) warfarin use ≥3 years. Non-use was defined as no use of warfarin over the follow-up period. Propensity scores (PS) for warfarin use were calculated using logistic regression with long-term use of warfarin as the dependent variable and age, sex, body mass index (BMI), history of multiple falls, deep venous thrombosis, pulmonary embolism, heart failure, neuropsychiatric impairment, hyperthyroidism, estrogen use, beta blockers, corticosteroids, bisphosphonates, smoking and alcoholism as independent variables. Each warfarin user was then matched by PS to a non-user by the “greedy matching” method. Incidence rates were calculated for warfarin users and non-users. The association between long-term warfarin use and risk of hip, spine and wrist fractures was evaluated using Cox-proportional hazards models. RESULTS: Incidence rates of hip fracture were 5.21 and 6.20 per 1000 person-years among subjects with warfarin use >1 (n=20,346) and >3 (n=11,238) years, respectively. The hazard ratios of hip fracture for warfarin use >1 and >3 years were 1.08 (95% CI 0.87, 1.35) and 1.13 (95% CI: 0.84, 1.5), respectively. Similar findings were observed between warfarin use and risk of spine or wrist fracture. CONCLUSIONS: Long-term use of warfarin among older adults with atrial fibrillation is not associated with increased risk of osteoporotic fractures and thus, does not necessitate additional surveillance or prophylaxis. / 2031-01-01

The differential susceptibilities of warfarin-susceptible LAC-grey and warfarin-resistant HC house mice to the anticoagulant effect of the oral rodenticide 3-(alpha-acetonyl benzyl)-4-hydroxycoumarin (Warfarin) in terms of their blood clotting times, were determined. The hypoprothrombinaemic effect of both the R(+) and S(-) warfarin enantiomers was also investigated, in addition to the standard test for warfarin-resistance in mice, the ability to survive on a diet containing 0.025% warfarin for 21 days. Onto this base of knowledge of the exact hypoprothrombinaemic responses evoked by treatment of both warfarin- susceptible and warfarin-resistant mice with warfarin at various doses, a structured analysis of the biochemical consequence(s) of expression of the major warfarin-resistance gene, War, could be built. Thus, changes in the in vivo pharmacokinetic parameters including half-life (t[1/2]), plasma clearance (Cl[p]), apparent volume of distribution (Vd[app]) and bioavailability (F) were documented for both R(+) and S(-) warfarin in both males and females of the two mouse strains. Similarly, in vitro hepatic microsomal metabolite profiles following pretreatment with warfarin, phenobarbitone, beta-naphthoflavone and clofibrate, excretion of unchanged warfarin enantiomers and warfarin metabolites and finally plasma protein binding parameters were determined in LAC-grey and HC mice. Therefore, it was possible to correlate changes in the pharmacokinetics, metabolism and disposition of warfarin in these mice with their differential anticoagulant sensitivities. Accordingly, the biochemical mechanism(s) of the expression of the major warfarin-resistance gene, War, has (have) been proposed to be due, at least in part, to a combination of a greater plasma clearance of the more potent S(-) warfarin enantiomer in females, a larger hepatic uptake of the same enantiomer in both sexes, and a greater degree of plasma protein binding of both enantiomers of warfarin.

Background Number of patients treated with medicine that has an anticoagulation character is constantly increasing. Chronic atrial fibrillation is the most common diagnosis being treated, but other diagnoses such as venous thrombosis), pulmonary embolism, stroke, coronary stent thrombosis and arterial thrombosis treated. There are a variety of anticoagulant drugs. In Sweden Warfarin is used as standard medicine for oral anticoagulation therapy. Purpose The purpose of this study is to examine and reflect nurses' experiences of working on anticoagulation clinic, and if he / she claims to have access to the necessary skills and resources to carry out a safe care. Design The study has a qualitative design with semi-structured interviews which were analyzed with an inductive approach. The interviews included six respondents. Findings The results showed that nurses who worked at anticoagulation Clinics had no specific training to operate these clinics. Respondents felt that they had obtained their knowledge through practical experience. However, previous research and Welfare guidelines emphasize the importance of continuous training. Even The National Board of Health and Welfare in Sweden requires that nurses should have significant skills to be able to provide good and safe care with high quality. Conclusion From these results it was concluded that the nurses who worked in anticoagulation clinics felt that they were able to do their work even though they had no specific training. However they considered that a basic theoretical knowledge could contribute to a more secure feeling regarding patient safety. Keywords Wafarinmonitoring, patient safety, Warfarin, Nurse

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Michigan, 1971.

Thesis (M.S.)--University of Michigan, 1971.

Objectives: To describe patient characteristics and evaluate costs and outcomes of novel oral anticoagulants compared to clinic-monitored warfarin for the prevention of stroke and systemic embolism in patients with atrial fibrillation within the Scott & White Healthcare system. Methods: Patients with atrial fibrillation, CHADS₂ score ≥ 1, and a prescription claim for dabigatran, rivaroxaban, or warfarin between 2010 and 2012 were evaluated over 12 months. Patients in the warfarin cohort were enrolled in an Anticoagulation Clinic. Patients were matched 1:1 for age, CHADS₂, and gender for comparisons between groups. Baseline characteristics, medication adherence, occurrence of adverse events, and treatment costs were compared using inferential statistics. Anticoagulation control was assessed for patients in the warfarin cohort. Results: 141 and 471 patients met criteria for the novel cohort group and the warfarin group, respectively. After matching, 136 remained in each cohort. Prior to matching, compared to the warfarin cohort, the novel anticoagulant cohort had a higher proportion of male patients (63% versus 49%), and lower average CHADS₂ score (2.65 versus 3.30), while average age in both cohorts was similar (75 years). Matched cohorts had similar adherence rates (88% for novel versus 87% for warfarin). After matching, annual medication cost in 2014 US dollars for dabigatran or rivaroxaban averaged $2,658 (SD $1,494) compared to $1,066 (SD $633) for warfarin, including monitoring costs. Annual total all-cause healthcare costs averaged $23,711 (SD $22,910) for dabigatran or rivaroxaban, compared to $18,248 (SD $24,184) for warfarin. For the 95 warfarin patients with INR values, time in therapeutic range averaged 70.4%. Conclusion: Compared to clinic-monitored warfarin, more men than women were prescribed new oral anticoagulants and these patients averaged a lower CHADS₂ score. After matching, patient adherence was high and comparable between groups. Anticoagulation control for warfarin patients was similar to clinical trials. Annual medication cost was significantly greater for new oral anticoagulants than clinic-monitored warfarin, including INR monitoring costs. Total annual all-cause healthcare costs were significantly greater for patients taking new oral anticoagulants compared to warfarin, although too few adverse events occurred to draw conclusions regarding event rates and costs of ischemic stroke and major bleeds. / text

Class of 2012 Abstract / Objectives: To evaluate the literature with respect to drug-drug interactions of the hydroxymethylglutaryl CoA reductase inhibitors atorvastatin, fluvastatin, lovastatin, pitavastitin, pravastatin, simvastatin, and rosuvastatin with warfarin. Methods: This descriptive retrospective study identified articles reporting on each drug-drug interaction from the online databases PubMed (1970 – February 2012) and the drug compendia Micromedex and Facts & Comparisons. The studies included in this investigation were primary literature reports, written in English with human subjects. All studies included were evaluated using the van Roon 5-point quality of evidence scale developed in the Netherlands to assess drug-drug interactions. This scale rates the study type from lowest to highest quality, from zero to four. Case-reports were evaluated using the Drug Interaction Probability Scale (DIPS). The DIPS tool uses 10 questions to evaluate the probability that an adverse event is caused by a drug-drug interaction. Results: Twenty studies met the inclusion criteria. One study involved atorvastatin, four for fluvastatin, three for lovastatin, 2 for pitavastatin, 1 for pravastatin, 5 for rosuvastatin, and 6 for simvastatin. The mean van Roon quality of evidence score was 2.1+/- 0.74, the mean score for atorvastatin, pitavastatin, and pravastatin was 3, with the mean score of fluvastatin, lovastatin, rosuvastatin, and simvastatin was 2. 70% of the literature reviewed were case-reports or letters. Conclusions: The studies and reports supporting HMG-CoA reductase inhibitors and warfarin drug-drug interactions are most commonly case- reports and are of low quality and quantity.