Antikoagülasyon Tedavisinde Sosyal Belirleyicilerin Kanama Sonuçları Üzerindeki Etkisinin İncelenmesi: Kapsam İncelemesi

Abstract

Giriş Oral antikoagülasyon (OAK) kontrolü, istenmeyen kanama olasılığını azaltır ve hastanın kanının pıhtılaşmasını geciktirir. Sosyal belirleyiciler, örneğin sosyoekonomik durum, cinsiyet, yaş, ırk/etnik köken, alkol kullanımı gibi faktörler ile oral antikoagülanların reçetelenme alışkanlıkları ve kanama olaylarında farklılıklar gözlemlenmiştir. Amaç Çalışmanın amacı, oral antikoagülan kullanan hastalarda sosyal belirleyicilerin kanama üzerindeki etkisini incelemektir. Sonuç Düşük sosyoekonomik durum, bu hastalar arasında kanamaya bağlı ölümlerde önemli bir belirleyicidir. Düşük gelirli bireylerin ve siyahi hastaların oral antikoagülan tedaviye erişme olasılığı daha düşüktür. İleri yaş, antikoagülan tedavide kanama riskinin önemli bir sosyal belirleyicisidir ve yaş ilerledikçe kanama riski artar. Cinsiyet değişkeninin, Uluslararası Normalleştirilmiş Oran (INR) kontrolü ve kanama riski açısından anlamlı bir etkisi olmamıştır. Genel alkol kullanımı kanama riskini belirlemede sosyal bir belirleyici olarak görülmemektedir. Ancak kanama riskinin belirlenmesinde hastaların ağır alkol kullanımı ve sosyoekonomik durumları değerlendirilmelidir. Klinik çıkarımlar Etnik köken ve sosyoekonomik durum, sağlık profesyonelleri tarafından hasta bakımının yönetilmesinde ve antikoagülan tedavi kullanan hastalarda kanama riskinin değerlendirilmesinde önemli parametrelerdir. Hemşireler, hasta öyküsünü dikkatlice değerlendirmeli ve bu hastalarda daha sık INR izlemesi yapılmalıdır. Literatür, özellikle farklı ırk ve alkol gibi sosyal belirleyicileri olan hastalar arasında oral antikoagülan tedavisindeki eşitsizlikleri ele almak için daha fazla araştırma yapılması gerektiğini belirtmektedir.

Keywords

• Antikoagülan
• Kanama
• Cinsiyet
• Tromboz
• Etnisite

Examining The Influence of Social Determinants on Bleeding Outcomes in Anticoagulation Therapy: A Scoping Review

Abstract

Background Oral anticoagulation (OAC) control reduces the likelihood of unwanted bleeding and delays the patient's blood clotting. Differences in prescription patterns and bleeding events of oral anticoagulants have already been observed concerning social determinants, such as socioeconomic status, gender, age, race/ethnicity, alcohol use, etc. Purpose The objective of the study is to examine the effect of social determinants on bleeding in patients using oral anticoagulants. Conclusions Low socioeconomic status is a significant determinant in bleeding-related deaths among these patients. Low-income individuals and black patients are less likely to access oral anticoagulant therapy. Older age is a crucial social determinant of bleeding with anticoagulant therapy, and the bleeding risk rises with advancing age. Although the gender variable did not have a significant effect in terms of International Normalized Ratio (INR) control and bleeding risk. General alcohol use is not a social determinant in determining the risk of bleeding. However, the heavy alcohol use and socioeconomic status of the patients should be assessed in determining the risk of bleeding. Clinical implications Ethnicity and socioeconomic status are important parameters in the management of patient care by healthcare professionals and in evaluating the risk of bleeding in patients using anticoagulant therapy. Patient history should be carefully evaluated by nurses and more frequent INR monitoring should be done in these patients. The literature indicates that more research is needed to understand underlying factors and develop strategies to address disparities in the use of oral anticoagulant therapy among patients of especially different racial and alcohol social determinants.

Keywords

• Anticoagulant
• Bleeding
• Gender
• Thrombosis
• Ethnicity

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