Evaluation of patients’ knowledge on their vitamin K antagonist treatment

##plugins.themes.academic_pro.article.sidebar##

Published Sep 4, 2018
Download
pdf
Vol. 96 No. 3 (2018): Issue Mar 2018

##plugins.themes.academic_pro.article.main##

Khadija Mzoughi
Ihsen Zairi
Fadoua BenGhorbel
Mouna Ben Kilani
Sofien Kamoun
Fethia Ben Moussa
Sana Fennira
Sondos Kraiem

Abstract

Introduction:
Vitamin K antagonists (VKA) are currently the most prescribed oral anticoagulant treatment in Tunisia. Despite the standardization of biological monitoring and the better definition of therapeutic objectives, their side effects are a frequent reason for hospitalization.

Aim: To evaluate patients' knowledge about their VKA treatment.   

Methods: We realized a cross-sectional descriptive study in the Cardiology Department of HabibThameur Hospital from September to October 2016. A questionnaire consisting of 14 items was used in a semi-directed interview in order to assess patients' knowledge on their VKA treatment.

Results: Our study included one hundred patients. Mean age was 61 ± 12 years and sex ratio of 1.8. Forty-eight per cent were illiterate. The median duration of AVK intake was 5 years. Atrial fibrillation (AF) was the most frequent indication (57%). Eighty percent of patients had more than five correct answers on the eight items of knowledge: VKA’s name (96%), tablet description (93%), dose (99%), time (94%), VKA’s effect (70%), INR (56%), treatment’s risk (49%) and the target INR (20%).
Twenty-two percent had more than four correct answers on the 6 items of know-how: what to do in case of haemorrhage (70%), what to do in case of oblivion (45%), interactions precautions to be observed with food (13%), activities advised against (49%) and medical procedures advised against (27%).
In multivariate analysis, only prior VKA information was significantly associated with a better knowledge of VKA (p = 0.027).

Conclusion: Our patients' knowledge on their VKA treatment was insufficient to ensure the safety and efficacy of treatment. The creation of a therapeutic education program on is therefore necessary to reduce the iatrogenic risk of this treatment.

Keywords:

Vitamin K antagonist- Indication - Therapeutic education - Knowledge.

##plugins.themes.academic_pro.article.details##

References

  1. Agence nationale de sécurité du médicament et des produits de santé (ANSM). Les nouveaux anticoagulants oraux; 2014. Available from: http://www.ansm.sante.fr/Dossiers/Les-anticoagulants/Les-anticoagulants-en-France-Etudes-et-surveillance/(offset)/0.
  2. Haute Autorité de Santé. Surdosage en AVK: situations à risque et accidents hémorragiques: synthèse des recommandations 2008. Available from: http://www.has-sante.fr/portail/jcms/c_682188/prise-en-charge-des-surdosages-des-situations-a-risque-hemorragique-et-des-accidents-hemorragiques-chez-les-patients-traites-par-antivitamines-k-en-ville-et-en-milieu-hospitalier.
  3. Hoffman JL, Aneese NJ, Schmidt KJ, Chaben AC, Smythe MA. Optimizing Anticoagulation Management Through the Use of a Hospital Engagement Network Metric for Inpatient Anticoagulant-Associated Hemorrhage. Ann Pharmacother. 2015;49(12):1305-10.
  4. Ben Ameur Y, Chaabane O, Zairi I, Longo S, Battikh K, Slimane ML. Hémorragies secondaires aux antivitamines K. Etude descriptive et pronostique. Tunis Méd. 2009;87(11):763-9.
  5. Ibn Haj Amor H. Surdosage en antivitamine K : Expérience de l'hôpital militaire. Thèse. Faculté de medecine de Monastir; 2012.
  6. Pernod G, Labarere J, Yver J, Satger B, Allenet B, Berremili T, et al. EDUC'AVK: reduction of oral anticoagulant-related adverse events after patient education: a prospective multicenter open randomized study. J Gen Intern Med. 2008;23(9):1441-6.
  7. Janoly-Duménil A, Bourne C, Loiseau K, Luauté J, Sancho PO, Ciancia S, et al. Oral anticoagulant treatment - Evaluating the knowledge of patients admitted in physical medicine and rehabilitation units. Ann Phys Rehabil Med. 2011;54(3):172-80.
  8. Briggs AL, Jackson TR, Bruce S, Shapiro NL. The development and performance validation of a tool to assess patient anticoagulation knowledge. Res Social Adm Pharm.. 2005;1(1):40-59.
  9. Taylor FC, Ramsay ME, Tan G, Gabbay J, Cohen H. Evaluation of patients' knowledge about anticoagulant treatment. Qual Health Care. 1994;3(2):79-85.
  10. Zeolla MM, Brodeur MR, Dominelli A, Haines ST, Allie ND. Development and validation of an instrument to determine patient knowledge: the oral anticoagulation knowledge test. Ann Pharmacother. 2006;40(4):633-8.
  11. Tang EO, Lai CS, Lee KK, Wong RS, Cheng G, Chan TY. Relationship between patients' warfarin knowledge and anticoagulation control. Ann Pharmacother. 2003;37(1):34-9.
  12. Samadoulougou A, Temoua Naibe D, Mandi G, Yameogo RA, Kabore E, Millogo G, et al. Evaluation du niveau de connaissance des patients sur la gestion du traitement par les antis vitamines K dans le service de cardiologie de Ouagadougou. Pan Afr Med J. 2014;19:286.
  13. Bidon D, Lecoeur A, Segui E, Seguette N, Le Mercier F, Bauler S. Follow-up of patients treated by VKA: Interest of a pharmaceutical link between the hospital and the retail pharmacies. Ann Pharm fr. 2017;75(1):45-53.
  14. Castets S. Le traitement par anti-vitamine K en médecine générale : Indications, suivi et implication du praticien dans sa gestion. Etude sur 389 patients. Universite Joseph Fourier, Faculté de Médecine de Grenoble.2006.
  15. Khan TI, Kamali F, Kesteven P, Avery P, Wynne H. The value of education and self-monitoring in the management of warfarin therapy in older patients with unstable control of anticoagulation. Br J Haematol. 2004;126(4):557-64.
  16. Palareti G, Legnani C, Guazzaloca G, Lelia V, Cosmi B, Lunghi B, et al. Risks factors for highly unstable response to oral anticoagulation: a case-control study. Br J Haematol. 2005;129(1):72-8.
  17. Recensement de la population en 2014 Tunisie: institut national des statistiques;2014. Available from: http://census.ins.tn/fr/resultats#horizontalTab2
  18. Haute Autorité de Santé (HAS) . Recommandations: Éducation thérapeutique du patient .Définition, finalités et organisation. Juin 2007.