anti coagulation survey final results slides pdf
TRANSCRIPT
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 1/19
Anticoagulation Therapy after Aortic
Tissue Valve ReplacementFinal Results
CTSNet Editors,
Valve Technology Center
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 2/19
6/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 2
Objectives
Primary: To determine the frequency of awareness among CTSNetsurgeons of the American College of Cardiology guidelines for post-op
warfarin therapy in patients with tissue valve replacement.
Secondary: To determine whether awareness of these guidelines
affects anticoagulation practices following aortic tissue valve
replacement (ATVR).
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 3/19
6/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 3
Methods
Study Population: Surgeon members of CTSNet who perform aortic
tissue valve replacement (ATVR) procedures.
Recruitment: Blast email notification of online survey instrument.
Announcement on CTSNet Home Page and Valve Technology Center
home page.
Design: Cross-sectional study. Surgeons completed online survey
accessed through www.CTSNet.org. Member login required. Single
submission. June 30, 2003 – August 28, 2003.
Analysis: Descriptive statistics.
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 4/196/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 4
Results: Awareness of ACC Guidelines
726 CTSNet-member surgeons completed the survey. – 79% were aware of ACC post-op warfarin guidelines
– 21% were not aware of the ACC guidelines
The following results are segmented as follows:
– All respondents
– Know ACC Guidelines
– Don’t Know ACC Guidelines
Note: ATVR = Aortic Tissue Valve Replacement
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 5/196/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 5
Region of Practice
Region of Respondent's Practice
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
A s i a
C a n a
d a
E u r o
p e
U n i t e
d S t a
t e s
O t h e
r
Region of Practice
P e r c e n t o f R e s p o n d e n t s
All Respondents
Know ACC Guidelines
Don't Know ACC
Guidelines
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 6/196/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 6
ATVR Procedures Performed Last Year
Number of Aortic Tissue Valve ReplacementProcedures Performed Last Year
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
< 20 21-
30
31-
40
41-
50
51-
60
61-
70
> 70
Number of Cases
P e r c e
n t o f R e s p o n d e n t s
All Respondents
Know ACC Guidelines
Don't Know ACC
Guidelines
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 7/196/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 7
ATVR Procedures Performed Last Year
Number of Aortic Tissue Valve ReplacementProcedures Performed Last Year
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
< 20 21-
30
31-
40
41-
50
51-
60
61-
70
> 70
Number of Cases
P e r c e
n t o f R e s p o n d e n t s
All Respondents
Know ACC Guidelines
Don't Know ACC
Guidelines
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 8/196/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 8
Change in Procedure Volume from Previous Year
Change in Procedure Volume from Previous Year
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%60.0%
70.0%
80.0%
Up Down
Change in Procedure Volume
P e r c e
n t o f R e s p o n
d e n t s
All Respondents
Know ACC Guidelines
Don't Know ACC
Guidelines
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 9/196/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 9
Percent of ATVR Patients with Comorbidities
Requiring Post-op Warfarin Therapy
Percent of ATVR Patients With Comorbidities that wouldRequire Warfarin Therapy During Post-op Hospital Stay
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
0 - 1 0
%
1 1 - 2
0 %
2 1 - 3
0 %
3 1 - 4
0 %
4 1 - 5 0
%
5 1 - 6
0 %
6 1 - 7 0
%
7 1 - 8
0 %
8 1 - 9
0 %
9 1 - 1
0 0 %
Percentage of ATVR Patients with
Comorbidities that Require Therapy
P e
r c e n t o f R e s p
o n d e n t s
All Respondents
Know ACC Guidelines
Don't Know ACC
Guidelines
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 10/196/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 10
Expectation of Warfarin Treatment in ATVR Patients
without Comorbidities
General Expectation That Most ATVR Patients WithoutComorbidies Need to be Treated with Warfarin
0.0%
20.0%
40.0%
60.0%
80.0%
Yes No
Expectation Most ATVR Patients
Without Comorbidities Require
Therapy
P e r
c e n t o f R e s p o
n d e n t s
All Respondents
Know ACC Guidelines
Don't Know ACC
Guidelines
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 11/196/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 11
Percent Patients without Comorbidities Treated with
Warfarin for 3 Months after ATVR
Percent of Respondent's Patients without ComorbiditiesTreated with Warfarin Therapy for Three Months Post ATVR
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
0 - 1 0
%
1 1 - 2
0 %
2 1 - 3
0 %
3 1 - 4
0 %
4 1 - 5 0
%
5 1 - 6
0 %
6 1 - 7 0
%
7 1 - 8
0 %
8 1 - 9
0 %
9 1 - 1
0 0 %
Percent of Patients
P e r c e n t o f R e s p o
n d e n t s
All Respondents
Know ACC Guidelines
Don't Know ACC
Guidelines
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 12/196/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 12
Belief that Post-Op Warfarin Rx Increases Length of
Stay in ATVR Patients without Comorbidities
Belief that Post-op Warfarin Therapy Following ATVRIncreases Hospital Stay in Patients Without Comorbidities
0.0%10.0%
20.0%
30.0%
40.0%
50.0%60.0%
70.0%
80.0%
Yes No
Belief Post-op Warfarin Therapy
Increases Hospital Stay
P e r c e n t o f R e s p o n
d e n t s
All Respondents
Know ACC Guidelines
Don't Know ACC
Guidelines
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 13/19
6/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 13
Average Increase in Length of Stay
Average No. of Days Post-op Warfarin Therapy FollowingATVR Increases Hospital Stay in Patients Without
Comorbidities
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
1 2 3 4
Average Number of Days
P
e r c e n t o f
R e
s p o n d e n t s
All Respondents
Know ACC Guidelines
Don't Know ACCGuidelines
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 14/19
6/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 14
Belief Anti-platelet Therapy is an Acceptable
Alternative to Warfarin Therapy
Belief that Anti-platelet Therapy is an Acceptable Alternativeto Warfarin Therapy after ATVR in Patients without
Comorbities
0.0%
10.0%20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Yes No Sometimes
Average Number of Days
P
e r c e n t o f
R e
s p o n d e n t s
All Respondents
Know ACC Guidelines
Don't Know ACCGuidelines
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 15/19
6/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 15
Prescription of Anti-platelet Therapy in ATVR
Patients without Comorbidities
Percentage of Respondent's ATVR Patients withoutComorbidities Prescribed Anti-platelet Therapy
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
0 - 1 0
%
1 1 - 2
0 %
2 1 - 3
0 %
3 1 - 4
0 %
4 1 - 5 0
%
5 1 - 6
0 %
6 1 - 7 0
%
7 1 - 8
0 %
8 1 - 9
0 %
9 1 - 1
0 0 %
Average Number of Days
P e r c e n t o f
R e s p o n d e n
t s
All Respondents
Know ACC Guidelines
Don't Know ACC
Guidelines
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 16/19
6/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 16
Safety, LOS and Cost with Anti-platelet Therapy
Alone in ATVR Patients without Comorbidities
Belief Anti-platelet Therapy Alone in ATVR Patientswithout Comorbidities Adequately Addresses Patient
Safety While Reducing LOS and Cost of Care
0.0%
20.0%
40.0%
60.0%
80.0%
Yes No
Belief Anti-platelet Therapy
Alone Addresses Patient Safety
P e r c e n t o f
R e s p o n d e n t s
All Respondents
Know ACC Guidelines
Don't Know ACC
Guidelines
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 17/19
6/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 17
Belief in Anti-platelet Therapy as Post-op Standard
Belief Anti-platelet Therapy Should be Post-op Standardof Care Following ATVR in Patients Without
Comorbidities
0.0%10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Yes No Sometimes
Belief Anti-platelet Therapy
Should be Standard of Care
P e r c e n t o f
R
e s p o n d e n t s
All Respondents
Know ACC Guidelines
Don't Know ACC
Guidelines
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 18/19
6/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 18
Belief Warfarin Therapy for Three Months NoLonger Standard of Care in ATVR Patients
without Comorbidities
Belief Warfarin Therapy for Three Months is No Longer
Standard of Care after ATVR in Patients without
Comorbidities
0.0%
20.0%
40.0%
60.0%
80.0%
Yes No
Belief Warfarin Therapy is No
Longer Standard of Care
P e r
c e n t o f
R e s p
o n d e n t s
All Respondents
Know ACC Guidelines
Don't Know ACC
Guidelines
8/4/2019 Anti Coagulation Survey Final Results Slides PDF
http://slidepdf.com/reader/full/anti-coagulation-survey-final-results-slides-pdf 19/19
6/3/2004 © 2004 by CTSNet. Anticoagulation Therapy after Aortic Tissue Valve Replacement. 19
Conclusions
Most respondents (80%) are familiar with the ACC guidelines on
anticoagulation therapy following aortic tissue valve replacement.
Yet, most respondents do not strictly adhere to those guidelines.
Many surgeons believe that anti-platelet therapy, rather than
warfarin, may be adequate following aortic tissue valve
replacement in patients without comorbidities.