Prospective Evaluation of an Extended Interval of INR Follow-up in a VA Anticoagulation Service

NCT ID: NCT02392104

Last Updated: 2019-12-11

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

51 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-03-27

Study Completion Date

2017-06-25

Brief Summary

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The purpose of this study is to determine the feasibility, safety, and acceptability of implementing an extended interval of INR follow-up in Veterans on a stable dose of warfarin in the Anticoagulation Clinic at the William S. Middleton Memorial Veterans Hospital.

All participants will be provided usual care from the anticoagulation clinic, except for the interval between INRs. If the participant continues to be on a stable dose of warfarin and the INRs are within the goal range of 2-3 (including lab variation), follow-up visits will be scheduled following an extended interval protocol. Patient satisfaction will be evaluated at various points throughout the study. Additionally provider satisfaction, confidence, and knowledge of the extended interval protocol will be analyzed. Bleeding and thromboembolic events will be evaluated to ensure the safety of an extended follow-up interval.

Detailed Description

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The purpose of this study is to determine the feasibility, safety, and acceptability of implementing an extended interval of INR follow-up in Veterans on a stable dose of warfarin in the Anticoagulation Clinic at the William S. Middleton Memorial Veterans Hospital.

All participants will be provided usual care from the anticoagulation clinic, except for the interval between INRs. If the participant continues to be on a stable dose of warfarin and the INRs are within the goal range of 2-3 (including lab variation), follow-up visits will be scheduled following an extended interval protocol, from 5-6 weeks, to 7-8 weeks, to 11-12 weeks and then continued with 11-12 week visits if INRs continue to remain in goal range and appropriate for the patient. Patient satisfaction will be evaluated at baseline, 6-, 12-, and 24-months. Additionally provider satisfaction, confidence, and knowledge of the extended interval protocol will be analyzed. Bleeding and thromboembolic events will be evaluated to ensure the safety of an extended follow-up interval.

Conditions

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Anticoagulation

Keywords

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International Normalized Ratio Warfarin

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Intervention Arm

All patients in the study will be in the intervention arm.

Group Type EXPERIMENTAL

Warfarin

Intervention Type DRUG

If the patient's INRs stay within goal range, their interval of INR follow-up will be extended based on a protocol to a maximum of 12 weeks.

Interventions

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Warfarin

If the patient's INRs stay within goal range, their interval of INR follow-up will be extended based on a protocol to a maximum of 12 weeks.

Intervention Type DRUG

Other Intervention Names

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Coumadin

Eligibility Criteria

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Inclusion Criteria

* 18 years of age or older
* requirement for indefinite warfarin therapy
* target INR of 2-3
* stable weekly warfarin dose for the past 6 months (not more than a single, one-time adjustment (boost/omission) in the past 6 months, planned interruption for a procedure or surgery with INR(s) out of range in the past 6 months would not exclude a patient)
* a patient of the Madison VA anticoagulation clinic for the previous 12 months

Exclusion Criteria

* consistently drink ≥4 alcoholic beverages/day or a documented episode of alcohol binging in the past 6 months
* diagnosis of cancer and on active chemotherapy/radiotherapy in the past 3 months
* life expectancy of \< 1 year
* enrolled in other investigational drug protocols
* only receiving anticoagulation care at the Madison VA for part of the year (e.g. snowbirds)
* receiving visiting nurse services for INR monitoring
* thrombocytopenia (\<100K) within past 12 months
* history of bleeding or thromboembolism requiring medical intervention within past 6 months
* treatment for active liver disease (e.g. hepatitis)
* diagnosis or documentation in EMR suggesting cognitive impairment
* activated power of attorney
* inability to provide informed consent
* non-English speaking
* unstable mental health disorder that impairs judgment
* history of non-adherence to anticoagulation clinic policies and procedures (i.e. missed appointments, self-adjustment of warfarin dose, nonadherence, etc.).
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Wisconsin, Madison

OTHER

Sponsor Role collaborator

William S. Middleton Memorial Veterans Hospital

FED

Sponsor Role lead

Responsible Party

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Carla Staresinic

Manager, Anticoagulation Services

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Carla Staresinic, PharmD

Role: PRINCIPAL_INVESTIGATOR

William S. Middleton Memorial Veterans Hospital

References

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Schoen RR, Nagy MW, Porter AL, Margolis AR. Patient Satisfaction With Extended International Normalized Ratio Follow-up Intervals in a Veteran Population. Ann Pharmacother. 2020 May;54(5):442-449. doi: 10.1177/1060028019889414. Epub 2019 Nov 21.

Reference Type DERIVED
PMID: 31752504 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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2014-1296

Identifier Type: -

Identifier Source: org_study_id