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Background: Oral anticoagulation (OAC) is used in neurology practice for primary and secondary stroke prevention in atrial fibrillation (AF), prosthetic mechanical valve; dilated cardiomyopathy (DCMP) and cerebral venous sinus thrombosis (CVST). This study evaluates the quality of oral anticoagulation therapy in neurology patients. Methods: Patients attending neurology service in KPC Medical College and Hospital, Jadavpur, Kolkata, West Benga (India); who were prescribed oral anticoagulant (OAC) were included. The international normalized ratio (INR) values of the patients who were already on OAC were analyzed. The level of anticoagulation, factors interfering with OAC and complications were noted. Results: Total 90 patients were included in study with median age 35±10 years. Ten were excluded as follow up was not done properly. Final study involves 80 patients. Fifty-eight patients received OAC for stroke prevention, 17 for cerebral venous sinus thrombosis (CVST) and 5 for deep vein thrombosis (DVT). Follow up was done for 2 years. Of the total 947 INR reports, 362 were below and 231 were above the therapeutic level. Stable INR was obtained in 36 patients only. INR level was improved by dose adjustment in 25 patients, and dietary adjustment in eight patients. Five patients were sensitive and three were resistant to OAC. Complications were noted in 14 instances. Conclusions: Stable therapeutic INR is difficult to maintain in neurological patients. However, modification of diet, drug and dose of oral anticoagulant may help in stabilization of INR. The findings support the need for educational interventions to improve the knowledge regarding OAT and, thereby, prevention of stroke.
RESUMO
Justification: Asthma and allergic rhinitis together are part of the concept of ‘one airway, one disease’ or ‘united airway disease’. The management of allergic airway diseases should address this united concept and manage the issue by educating the patients and their parents and health care providers, along with environmental control measures, pharmacotherapy and immunotherapy. Here, we present recommendations from the module of ‘Airway Diseases Education and Expertise’ (ADEX) that focused on allergic rhinitis, asthma and sleep disorder breathing as a single entity or Allergic Airway Disease. Process: A working committee was formed by the collaboration of Pediatric Allergy Association of India (PAAI) and Indian Academy of Pediatrics (IAP) Allergy and Applied Immunology chapter to develop a training module on united airway disease. Objectives: To increase awareness, understanding and acceptance of the concept of "United Airway disease" and to educate the primary health care providers for children and public health officials, in the management of united airway diseases. Recommendations: Recommendations for diagnosis, management and follow-up of Allergic airway disease are presented in this document. A better compliance by linking education of child, parent, grandparents and other health care providers, and scientific progress by collaboration between practitioners, academicians, researchers and pharmaceutical companies is suggested.