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The relative healthy, young patient with AF (or VTE), but it is prone to fail in the elderly. Meanwhile, many laboratories throughout the world are actively arranging laboratory assays to become available. These comprise routine assays like aPTT and PT, provided reagents are sensitive to detect the effects of NOAC's [41,42]. For quantitative purposes several assays are commercially available, including a modified thrombin clotting time for dabigatran and anti-Xa based assays for FXa inhibitors. Using specific calibrators therapeutic levels of NOACs can thus be measured. While point of care assays are particularly wanted for emergency settings, quantitative assays may find a place for eventual dose adjustment purposes. The idea of implementing laboratory testing for NOACs on a routine basis is currently not useful, PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/21715270 in the absence of therapeutic target levels (and because specific dose regimens instead of variable doses, have been registered).Adherence to NOAC's?Amazingly little literature is available regarding adherence to anticoagulant therapy. While there is an array of published reports and expert committee discussion papers on non-adherence of medication (as summarized in 37?9), particularly for the long term, there is no database on anticoagulants. Apparently, the general perception is that VKA monitoring with INR provides a tool for maintaining patients adherent. On the other hand, it is commonly known that adherence cannot be forced on persons by single measurements. A good example 3-(2,2,2-Trifluoroethoxy)aniline hydrochloride is theso-called white coat adherence of patients to antihypertensive drugs (summarized in the recent think-tank paper, 38). A time window of about 5 days before and after the blood pressure reading conveys a short-term adherence effect [38]. In analogy with PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/10572343 blood pressure monitoring, more sustainable forms of adherence stimulation are required, also in current patients on VKA therapy. Consensus is that with CV medication for chronic use the non-adherence rate adds up to 50 , translating to about 125.000 deaths in the USA annually [37,38]. The total costs of non-adherence range between 100 and 300 billion US per year. It has also been estimated that with every extra dollar spent on adherence enhancing measures an average of about 4? US is saved in preventing major complications and death in diseases including diabetes, hypertension and hypercholesterolemia [37,38]. Many individual factors determine adherence and overall, there are no major differences in these factors per type of indication or population. Motivation to take medication is for one determined by the perception of symptoms. In case of hypertension, patients are more motivated to continue medication if they perceive a certain benefit (reduced headache, less palpitations etc.). However, in the absence of such symptoms, adherence drops and this may occur with NOAC therapy, where (possibly with the exception of the acute phase of VTE), symptoms are absent (most apparently in AF patients). Thus, it can be expected that in the management of NOAC's non-adherence may reach comparable figures (?0 ) if no measures to boost adherence are being taken. The argument that in trials fixed dose therapy was as good 1-(5-(Aminomethyl)-2-nitrophenyl)ethanol as monitored warfarin does not take into account that trial patients are motivated, literate and get frequent follow up attention by trial nurses about any side effects etcetera. Moreover, potentially non-adherent patients were excluded, at least in some trials. Hence, these trial data are unlik.