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In nursing research, language and sensitive questions should be looked into carefully in order to get the correct information required. The respondents as well as the whole community need respect; justice and contextual care. The researcher should at no cost disclose the personal information nor force the respondents to answer.
This research used random sampling to study the population in clinical trials, where a sample of 8803 patients was chosen. The research design is a randomized experiment or true experiment since random assessment is used.
Coronary artery disease had caused deaths among adults in the U.S.A.; though studies had been conducted to address the use of long-term Oral Anticoagulation (OAC) after myocardial infarction. The study purposely evaluated the risks and benefits associated with OAC after myocardial infarction. The question was whether additional OAC advances outcomes. Recent studies showed that not only the young men would survive but also other patients. Different trials had been conducted giving different results. A meta-analysis of randomized clinical examination was conducted which compared OAC- based treatments; and no OAC after myocardial infarction in the event of survival, of those patient taking OAC. The research significantly indicated that OAC despite elevating chances of major bleeding reduced instances of stroke.
A broad search of OVID SR and PubMed was executed where 66 citations were assessed at the abstract level. The inclusion standards required the use of chronic OAC with warfarin after infraction, equal chance controlled tests, at least 30-day follow-up where death was listed as the outcome. On the other hand, the exclusion standard required a demonstrated study and use of OAC, for other conditions except myocardial infarction. 52 citations were disqualified for not meeting inclusion/ exclusion standards for OAC administration. Fourteen studies were examined and only four studies were excluded since they did not meet the primary endpoint reporting measure.
The chief endpoint for every trial was a compound of ischemic events inclusion of death, infraction, stroke or repeated ischemia in different groupings. As the main focus was on all-cause mortality, individual ischemic events were tested as there was a probability of variations in response; amongst the components of the compound endpoint. Major and minor bleedings were analyzed separately and weighted fixed; and random effects methods used in performing statistical analysis. The variations were accounted in a chi-squire test where in every event; the collective result was illustrated as odd ratio with 95% confidence intervals.
From the results obtained, only five studies showed patients on OAC and aspirin against aspirin alone. On the other hand, four studies illustrated three arms that showed comparison of OAC alone against aspirin alone versus OAC with aspirin; while as only one study showed comparison of OAC against placebo, without aspirin in any of the arms. 93 to 8803 patients were studied where out of 24,542; 14,062 patients were assigned to OAC while the rest were assigned to no OAC. The patient follow-ups were for 3-63 months where only one study showed the ejection fraction. 25% of the patients were administered with reperfusion therapy. Only one study did not report myocardial as the endpoint and where the new infractions which occurred totaled to 9.9%. When assessing the effects of OAC of obligatory aspirin to patients with previous infraction; a division of patients (n-11920) selected; to aspirin against aspirin and OAC. OAC had no effects on the mortality or reinfraction but reduced stroke by 30% and raised the odds of major bleeding.
The findings showed that nearly 90,000 patient-years were followed by 25,000 patients with recent acute myocardial infraction. All cause-death or infraction dangers are not reduced by OAC, but it doubled the danger of major bleeding and reduced incidences of stroke. Among the studies there were variations for some endpoints but not for the efficacy and safety endpoints. The results illustrated that; for every 100 patients who received warfarin after a myocardial infraction, there was one major bleeding and four minor bleeding caused, and prevented only one stroke. Therefore, this implies that nursing should be done with warfarin after a myocardial infraction.
The Warfarin Aspirin Re-infraction Study indicated that OAC enhanced mortality acute myocardial infraction, as compared to placebo in nonappearance of aspirin therapy. Coumadin Aspirin Reinfraction Study (CARS) found no difference in mortality of 8803 patients treated with OAC alone, aspirin alone or the two combined; when a comparison of OAC with no OAC on aspirin background therapy was analyzed. The study showed that platelets play a crucial role in vascular thrombosis at the ruptured coronary atherosclerotic plague which leads to acute ischemic episodes.
The findings contributed a lot to nursing knowledge, since specialists would be in a position to know the right therapy for different patients. As an example, OAC do not reduce all-cause death or reinfraction risks but doubles the dangers of major bleeding. On the other hand it reduces instances of stroke. Therefore, by knowing this; scientists will decide whether to administer OAC or not. The research would impact all areas of nursing and calls for more education and administration of the drugs, with fewer effects on the patients.
The study had limitations in that, the tested respondents represented a more relatively healthy populace than those treated in daily practice; hence the study may have underestimated the importance of chronic OAC in patients with numerous comorbidities.
In conclusion, chronic OAC with warfarin does not trim down mortality or infraction. Patients who received OAC had a considerable elevated rate of bleeding which was equilibrated by a considerable reduction in stroke.
Reference
Polit, D. & Beck, C. (2003). Nursing Research: Principles and Methods, seventh edition. Lippicott Williams & Wilkins Press
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