Open Access Theses and Dissertations

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You searched for +publisher:"University of Illinois – Chicago" +contributor:("Nutescu, Edith A."). Showing records 1 – 3 of 3 total matches.

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University of Illinois – Chicago

1. Manzoor, Beenish S. Navigating Safety of Anticoagulant Use From Precision Medicine to Direct Oral Anticoagulants.

Degree: 2017, University of Illinois – Chicago

URL: http://hdl.handle.net/10027/22225 

Background: This dissertation focuses on assessing avenues for safe delivery of oral anticoagulants. In that, three studies have been undertaken to address gaps in practice pertaining to Vitamin K Antagonist (VKA) and direct-acting anticoagulant (DOAC) delivery using a mixed-methods approach. More specifically, we identified factors influencing pharmacogenetic (PGx) testing implementation into routine clinical care and assessed utilization patterns (adherence, persistence and transitions) among DOAC initiators Methods: Individual, face-to-face, semi-structured interviews were conducted with healthcare providers at an urban academic medical center to identify factors influencing PGx testing. Transcripts were analyzed thematically using constant comparison. Additionally, to assess utilization patterns in DOAC initiators, Truven Health MarketScan® Commercial and Medicare Supplemental databases were used (2009-2013). Atrial fibrillation (AF) patients newly initiating a DOAC with a minimum of 6 months of continuous health plan enrollment pre and post-index date were included in the cohort. DOAC adherence was measured as proportion of days covered (PDC). Results: Among 38 interviewees, 21 (55.3%) physicians and 17 (44.7%) pharmacists participated. Factors found to influence provider selection of PGx testing were perceptions related to the clinical utility of the PGx test, lack of comfort in interpretation of the test and lack of knowledge related to PGx. Among 66,090 DOAC users, adherence and persistence declined over time, but both declined in a greater magnitude for anticoagulant (AC) naïve compared to AC experienced. The mean PDC in AC naïve and non-AC naïve patients at 6 and 12 months was 72.3% vs. 83.3% (p<0.001) and 63.7% vs. 79.9% (p<0.001), respectively. Additionally, AC naïve user status was a predictor of lower adherence. Lastly, in a cohort of 34,022 AC naïve users, 6,613 (19.4) switched from their index DOAC. Of those that switched, 2912 (44.0%) switched to an alternate DOAC and 2,945 (44.5%) to warfarin. Interestingly, 48.3% patients switch within 6 months of therapy initiation. Conclusion: This dissertation presents timely studies focusing on contemporary practice in antithrombotic therapy. Addressing barriers to implementation of practice modalities such as PGx testing by increasing provider comfort, confidence and knowledge as well as providing enhanced, structured educational support to patients using DOACs are solutions to navigating safety in this evolving landscape. Advisors/Committee Members: Nutescu, Edith A (advisor), Sharp, Lisa K (committee member), Walton, Surrey M (committee member), Lee, Todd A (committee member), Galanter, William L (committee member), Nutescu, Edith A (chair).

Subjects/Keywords: anticoagulants; anticoagulation; safety; warfarin; dabigatran; rivaroxaban; apixaban; direct oral anticoagulants; pharmacogenetics; adherence

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Manzoor, B. S. (2017). Navigating Safety of Anticoagulant Use From Precision Medicine to Direct Oral Anticoagulants. (Thesis). University of Illinois – Chicago. Retrieved from http://hdl.handle.net/10027/22225

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16th Edition):

Manzoor, Beenish S. “Navigating Safety of Anticoagulant Use From Precision Medicine to Direct Oral Anticoagulants.” 2017. Thesis, University of Illinois – Chicago. Accessed February 25, 2021. http://hdl.handle.net/10027/22225.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7th Edition):

Manzoor, Beenish S. “Navigating Safety of Anticoagulant Use From Precision Medicine to Direct Oral Anticoagulants.” 2017. Web. 25 Feb 2021.

Vancouver:

Manzoor BS. Navigating Safety of Anticoagulant Use From Precision Medicine to Direct Oral Anticoagulants. [Internet] [Thesis]. University of Illinois – Chicago; 2017. [cited 2021 Feb 25]. Available from: http://hdl.handle.net/10027/22225.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Manzoor BS. Navigating Safety of Anticoagulant Use From Precision Medicine to Direct Oral Anticoagulants. [Thesis]. University of Illinois – Chicago; 2017. Available from: http://hdl.handle.net/10027/22225

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation


University of Illinois – Chicago

2. Drozda, Katarzyna. Warfarin Pharmacogenomic Implementation: Implications for Minorities and Opportunities for Education.

Degree: 2014, University of Illinois – Chicago

URL: http://hdl.handle.net/10027/19063 

Recent clinical trial results cast doubt on the utility of genotype-guided warfarin dosing, specifically showing worse dosing with a pharmacogenetic versus clinical dosing algorithm in African Americans. However, trials did not include many genotypes important in African Americans. We aimed to determine if omission of the CYP2C9*5, *6, *8, *11 and rs12777823G>A genotypes affects performance of pharmacogenetic dosing algorithms in African Americans. In a cohort of 274 warfarin-treated African Americans, we examined the association between CYP2C9*5, *6, *8, *11 and rs12777823G>A genotypes and warfarin dose prediction error with pharmacogenetic algorithms used in clinical trials. The warfarindosing.org algorithm over-estimated doses by a median (IQR) of 1.2 (0.02 to 2.6) mg/day in rs12777823 heterozygotes (p<0.001 for predicted versus observed doses), by 2.0 (0.6 to 2.8) mg/day with the rs12777823 A homozygotes (p=0.004), and by 2.2 (0.5 to 2.9) mg/day in carriers of a CYP2C9 variant (p<0.001). The International Warfarin Pharmacogenetics Consortium (IWPC) algorithm under-dosed warfarin by 0.8 (-2.3 to 0.4) mg/day for patients with the rs12777823 GG genotype (p<0.001) and over-dosed warfarin by 0.7 (-0.4 to 1.9) mg/day in carriers of a variant CYP2C9 allele (p=0.04). Modifying the warfarindosing.org algorithm to adjust for variants important in African Americans led to better dose prediction than either the original warfarindosing.org (p<0.01) or IWPC (p<0.01) algorithms. These data suggest that, when providing genotype-guided warfarin dosing, it is important to account for variants prevalent in African Americans to avoid significant dosing error in this population. Advisors/Committee Members: Zwanziger, Jack (advisor), Bishop, Jeffrey R. (committee member), Cavallari, Larisa H. (committee member), Nutescu, Edith A. (committee member), Schumock, Glen T. (committee member).

Subjects/Keywords: Pharmacogenomics; warfarin; genotype; CYP2C9; rs12777823

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Drozda, K. (2014). Warfarin Pharmacogenomic Implementation: Implications for Minorities and Opportunities for Education. (Thesis). University of Illinois – Chicago. Retrieved from http://hdl.handle.net/10027/19063

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16th Edition):

Drozda, Katarzyna. “Warfarin Pharmacogenomic Implementation: Implications for Minorities and Opportunities for Education.” 2014. Thesis, University of Illinois – Chicago. Accessed February 25, 2021. http://hdl.handle.net/10027/19063.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7th Edition):

Drozda, Katarzyna. “Warfarin Pharmacogenomic Implementation: Implications for Minorities and Opportunities for Education.” 2014. Web. 25 Feb 2021.

Vancouver:

Drozda K. Warfarin Pharmacogenomic Implementation: Implications for Minorities and Opportunities for Education. [Internet] [Thesis]. University of Illinois – Chicago; 2014. [cited 2021 Feb 25]. Available from: http://hdl.handle.net/10027/19063.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Drozda K. Warfarin Pharmacogenomic Implementation: Implications for Minorities and Opportunities for Education. [Thesis]. University of Illinois – Chicago; 2014. Available from: http://hdl.handle.net/10027/19063

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation


University of Illinois – Chicago

3. Patel, Vardhaman. Direct Thrombin Inhibitors: Use and Consequences in Patients with Heparin-Induced Thrombocytopenia.

Degree: 2015, University of Illinois – Chicago

URL: http://hdl.handle.net/10027/19794 

Heparin-induced thrombocytopenia (HIT) is an immunologic response to heparin exposure that may lead to thrombosis. Argatroban and bivalirudin are two commonly used direct thrombin inhibitors (DTIs) for the prevention of thrombosis in patients with HIT. However, DTIs may lead to major bleeding events. Data on the use and consequences of DTIs is limited. Of note, patients with suspected HIT are of interest in the thesis, as current guidelines recommend the initiation of DTI treatment at the time of clinical suspicion of HIT. This thesis focused on the identification of suspected HIT, and the use and consequences of direct thrombin inhibitors (DTI) for the treatment of suspected HIT. First, algorithms based on diagnostic codes, medications and diagnostic tests were developed and validated to identify patients with suspected HIT. An algorithm based only on the timing of medication and diagnostic tests was recommended for the identification of suspected HIT from claims data, as it was observed to have the highest positive predictive value and sensitivity. Second, the rates of thrombosis, major bleeding, amputation and mortality were compared between argatroban-treated and bivalirudin-treated patients using administrative claims data obtained from the University HealthSystem Consortium. The difference in the likelihood of thrombosis, amputation and mortality between the two DTI groups was not statistically significant. However, bivalirudin-treated patients were more likely to experience major bleeding than argatroban-treated patients. Third, the use of bivalirudin for the treatment of suspected HIT (off-label use) increased from one-third to half of DTI-treated patients from 2010 to 2012. Patients treated by surgeons or specialists were more likely to receive off-label bivalirudin compared to patients treated by primary care. In addition, hepatic impairment and skin infection increased the odds of patients to receive bivalirudin over argatroban. In conclusion, the off-label use of bivalirudin should be scrutinized for medical necessity due to the higher risk of bleeding than argatroban, except in patients with hepatic impairment. Advisors/Committee Members: Walton, Surrey M. (advisor), Schumock, Glen T. (committee member), Lee, Todd A. (committee member), Galanter, William L. (committee member), Nutescu, Edith A. (committee member), Hohmann, Samuel F. (committee member).

Subjects/Keywords: 1; comparative effectiveness; 2; direct thrombin inhibitors; 3; argatroban; 4; bivalirudin; 5; thrombosis; 6; major bleeding; 7; safety; 8; off-label; 9; algorithms; 10; validity

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APA · Chicago · MLA · Vancouver · CSE | Export to Zotero / EndNote / Reference Manager

APA (6th Edition):

Patel, V. (2015). Direct Thrombin Inhibitors: Use and Consequences in Patients with Heparin-Induced Thrombocytopenia. (Thesis). University of Illinois – Chicago. Retrieved from http://hdl.handle.net/10027/19794

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Chicago Manual of Style (16th Edition):

Patel, Vardhaman. “Direct Thrombin Inhibitors: Use and Consequences in Patients with Heparin-Induced Thrombocytopenia.” 2015. Thesis, University of Illinois – Chicago. Accessed February 25, 2021. http://hdl.handle.net/10027/19794.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

MLA Handbook (7th Edition):

Patel, Vardhaman. “Direct Thrombin Inhibitors: Use and Consequences in Patients with Heparin-Induced Thrombocytopenia.” 2015. Web. 25 Feb 2021.

Vancouver:

Patel V. Direct Thrombin Inhibitors: Use and Consequences in Patients with Heparin-Induced Thrombocytopenia. [Internet] [Thesis]. University of Illinois – Chicago; 2015. [cited 2021 Feb 25]. Available from: http://hdl.handle.net/10027/19794.

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

Council of Science Editors:

Patel V. Direct Thrombin Inhibitors: Use and Consequences in Patients with Heparin-Induced Thrombocytopenia. [Thesis]. University of Illinois – Chicago; 2015. Available from: http://hdl.handle.net/10027/19794

Note: this citation may be lacking information needed for this citation format:
Not specified: Masters Thesis or Doctoral Dissertation

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