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dc.contributor.advisorNutescu, Edith Aen_US
dc.contributor.authorManzoor, Beenish Sen_US
dc.date.accessioned2018-02-08T21:30:52Z
dc.date.available2018-02-08T21:30:52Z
dc.date.created2017-12en_US
dc.date.issued2017-11-29en_US
dc.date.submittedDecember 2017en_US
dc.identifier.urihttp://hdl.handle.net/10027/22225
dc.description.abstractBackground: 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.en_US
dc.format.mimetypeapplication/pdfen_US
dc.subjectanticoagulantsen_US
dc.subjectanticoagulationen_US
dc.subjectsafetyen_US
dc.subjectwarfarinen_US
dc.subjectdabigatranen_US
dc.subjectrivaroxabanen_US
dc.subjectapixabanen_US
dc.subjectdirect oral anticoagulantsen_US
dc.subjectpharmacogeneticsen_US
dc.subjectadherenceen_US
dc.titleNavigating Safety of Anticoagulant Use From Precision Medicine to Direct Oral Anticoagulantsen_US
dc.typeThesisen_US
thesis.degree.departmentPharmacy Systems, Outcomes & Policyen_US
thesis.degree.grantorUniversity of Illinois at Chicagoen_US
thesis.degree.levelDoctoralen_US
thesis.degree.namePhD, Doctor of Philosophyen_US
dc.contributor.committeeMemberSharp, Lisa Ken_US
dc.contributor.committeeMemberWalton, Surrey Men_US
dc.contributor.committeeMemberLee, Todd Aen_US
dc.contributor.committeeMemberGalanter, William Len_US
dc.type.materialtexten_US
dc.contributor.chairNutescu, Edith Aen_US


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