Abstract
Objective: Warfarin is the most commonly used oral anticoagulant in the treatment and prophylaxis of thromboembolic diseases. In order to prevent thrombosis and to avoid hemorrhagic complications, the patient's International Normalized Ratio (INR) is kept within a certain range according to the indication and monitored at certain intervals. Our aim in our study is to determine the percentage of patients using warfarin for various indications reaching target INR values. Methods: Patients who used warfarin for various indications at our hospital's Internal Medicine outpatient clinic between May 2023 and November 2023 were included in our study, and their INR results were recorded by retrospectively scanning them. Results: A study group was formed with a total of 130 patients. Patients using warfarin due to metallic heart valve replacement, AF, PTE and CVD were evaluated separately according to the target INR value. The percentage of patients with metallic heart valve replacement reaching the target INR value of 2.5-3.5 was calculated as 38.5% (n: 27). The percentages of patients with AF, PTE and CVD reaching their target INR values of 2-3 were calculated as 40% (n:16), 54% (n:7), 70% (n:5), respectively. Considering the entire study group, the percentage of reaching the target INR was calculated as 42% (n: 55). Conclusion: As a result, warfarin not being within the therapeutic range causes serious morbidity and mortality. In our study, the percentage of patients reaching the target INR was found to be 42%. This percentage is very low, and in order to increase this rate, it is necessary to increase patient awareness, increase the frequency of follow-up of patients and develop more effective follow-up strategies.
Keywords
Ethical Statement
Sivas Cumhuriyet Üniversitesi Girişimsel Olmayan Etik Kurulundan 21/12/2023 tarihli 2023-12/07 karar no’lu etik kurul onayı alınmıştır.
References
- Barcellona D, Fenu L, Marongiu F. Point-of-caretesting INR: an overview. Clinical Chemistry and Laboratory Medicine (CCLM). 2017;55(6): 800-805.
- Leite PM, Martins MAP, Castilho RO. Review on mechanisms and interactions in concomitant use of herbs and warfarin therapy. BiomedPharmacother2016;83:14-21.
- Björck F, Renlund H, Lip GYH, Wester P, Svensson PJ, Själander A. Outcomes in a Warfarin-Treated Population With Atrial Fibrillation. JAMA Cardiol 2016;1(2):172–180.
- Rose AJ, Berlowitz DR, Miller DR, Hylek EM, Ozonoff A, Zhao S, Reisman JI, Ash AS. INR targets and site-level anticoagulation control: results from the Veterans AffaiRs Study to Improve Anticoagulation (VARIA). J Thromb Haemost 2012;10(4):590-5.
- Dorgalaleh A, Favaloro EJ, Bahraini M, Rad F. Standardization of Prothrombin Time/International Normalized Ratio (PT/INR). Int J Lab Hematol 2021;43(1):21-28.
- Rose AJ, Ozonoff A, Berlowitz DR, Henault LE, Hylek EM. Warfarin dose management affects INR control. J Thromb Haemost 2009;7(1):94-101.
- Horton, JD, Bushwick, BM. Warfarin therapy: evolving strategies in anticoagulation. American family physician, 1999;59(3): 635–646.
- Çelik A, İzci S, Kobat MA, Ateş AH, Çakmak A, Çakıllı Y, Yılmaz MB, Zoghi M; WARFARIN-TR Study Collaborates. The awareness, efficacy, safety, and time in therapeutic range of warfarin in the Turkish population: WARFARIN-TR. Anatol J Cardiol 2016;16(8):595-600.
- Macedo AF, Bell J, McCarron C, Conroy R, Richardson J, Scowcroft A, Sunderland T, Rotheram N. Determinants of oral anticoagulation control in new warfarin patients: analysis using data from Clinical Practice Research Datalink. Thromb Res 2015;136(2):250-60.
- Alışır MF, Keçebaş M, Beşli F, Çalışkan S, Güngören F, Yıldırım A, Baran İ, Aydınlar A. Varfarin Kullanan Hastalarda Etkin INR Düzeyi Oranları ve Etiyoloji ile Olan İlişkisi. Turkiye Klinikleri J MedSci 2013; 33:868-73.
- You JH, Chan FW, Wong RS, Cheng G. Is INR between 2.0 and 3.0 the optimal level for Chinese patients on warfarin therapy for moderate-intensity anticoagulation? Br J Clin Pharmacol 2005;59(5):582-7.
- Blackshear JL, Baker VS, Rubino F, Safford R, Lane G, Flipse T at al. Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke prevention in Atrial Fibrilation III Randomised Clinical Trial. The Lancet 1996;348(9028):633-638.
- Pengo V, Zasso A, Barbero F, Banzato A, Nante G, Parissenti L, John N, Noventa F, Dalla Volta S. Effectiveness of fixed mini dose warfarin in the prevention of thrombo embolism and vascular death in non rheumaticatrial fibrillation. Am J Cardiol 1998;82(4):433-7.
- Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, Camm AJ, Weitz JI, Lewis BS, Parkhomenko A, Yamashita T, Antman EM. Comparison of the efficacy and safety of new oral anti coagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014;383(9921):955-62.
- Gurwitz JH, Field TS, Radford MJ, Harrold LR, Becker R, Reed G, DeBellis K, Moldoff J, Verzier N. The safety of warfarin therapy in the nursing home setting. Am J Med 2007;120(6):539-44.
- McCormick D, Gurwitz JH, Goldberg RJ, Becker R, Tate JP, Elwell A, Radford MJ. Prevalence and quality of warfarin use for patients with atrial fibrillation in the long-term care setting. Arch Intern Med 2001;161(20):2458-63.
- Verhovsek M, Motlagh B, Crowther MA, Kennedy C, Dolovich L, Campbell G, Wang L, Papaioannou A. Quality of anti-coagulation and use of warfarin-interacting medications in long-term care: a chart review. BMC Geriatr 2008;8:13
Abstract
Amaç: Varfarin tromboembolik hastalıkların tedavisinde ve profilaksisinde en sık kullanılan oral antikoagülandır. Trombozun oluşmasını engellerken aynı zamanda hemorajik komplikasyonlardan kaçınmak için hastanın Uluslararası Normalleştirilmiş Oranı (INR) endikasyonuna göre belirli aralıkta tutulur ve belirli aralıklarla takip edilir. Bizim çalışmamızdaki amacımız çeşitli endikasyonlarda varfarin kullanan hastaların hedef INR değerlerine ulaşma yüzdesinin saptanmasıdır. Yöntem: Çalışmamıza hastanemize Mayıs 2023 ile Kasım 2023 tarihleri arasında İç Hastalıkları polikliniğine çeşitli endikasyonlar sebebiyle varfarin kullanan hastalar dahil edilmiş ve retrospektif olarak taranarak INR sonuçları kayıt altına alınmıştır. Bulgular: Toplam 130 hasta ile çalışma grubu oluşturulmuştur. Metalik kalp kapak replasmanı, AF, PTE ve SVH nedeniyle varfarin kullanan hastalar ayrı ayrı hedef INR değerine göre değerlendirilmiştir. Metalik kalp kapak replasmanlı hastaların hedef INR'ye ulaşma yüzdesi %38,5 (n: 27) olarak, AF, PTE ve SVH’li hastaların hedef INR’lerine ulaşma yüzdeleri sırasıyla %40 (n:16), %54 (n:7), %70 (n:5) olarak tespit edildi. Tüm çalışma grubu göz önüne alındığında ise hedef INR’ye ulaşma yüzdesi %42 (n:55) olarak hesaplandı. Sonuç: Sonuç olarak varfarinin terapötik aralıkta bulunmaması ciddi morbitide ve mortaliteye yol açmaktadır. Çalışmamızda hedef INR’ye ulaşan hasta yüzdesi %42 olarak saptanmıştır. Bu yüzde çok düşük olup, bu oranı artırmak için hasta farkındalığının artırılması, hastaların takip sıklığının artırılması ve daha etkili takip stratejileri geliştirilmesi gerekmektedir.
References
- Barcellona D, Fenu L, Marongiu F. Point-of-caretesting INR: an overview. Clinical Chemistry and Laboratory Medicine (CCLM). 2017;55(6): 800-805.
- Leite PM, Martins MAP, Castilho RO. Review on mechanisms and interactions in concomitant use of herbs and warfarin therapy. BiomedPharmacother2016;83:14-21.
- Björck F, Renlund H, Lip GYH, Wester P, Svensson PJ, Själander A. Outcomes in a Warfarin-Treated Population With Atrial Fibrillation. JAMA Cardiol 2016;1(2):172–180.
- Rose AJ, Berlowitz DR, Miller DR, Hylek EM, Ozonoff A, Zhao S, Reisman JI, Ash AS. INR targets and site-level anticoagulation control: results from the Veterans AffaiRs Study to Improve Anticoagulation (VARIA). J Thromb Haemost 2012;10(4):590-5.
- Dorgalaleh A, Favaloro EJ, Bahraini M, Rad F. Standardization of Prothrombin Time/International Normalized Ratio (PT/INR). Int J Lab Hematol 2021;43(1):21-28.
- Rose AJ, Ozonoff A, Berlowitz DR, Henault LE, Hylek EM. Warfarin dose management affects INR control. J Thromb Haemost 2009;7(1):94-101.
- Horton, JD, Bushwick, BM. Warfarin therapy: evolving strategies in anticoagulation. American family physician, 1999;59(3): 635–646.
- Çelik A, İzci S, Kobat MA, Ateş AH, Çakmak A, Çakıllı Y, Yılmaz MB, Zoghi M; WARFARIN-TR Study Collaborates. The awareness, efficacy, safety, and time in therapeutic range of warfarin in the Turkish population: WARFARIN-TR. Anatol J Cardiol 2016;16(8):595-600.
- Macedo AF, Bell J, McCarron C, Conroy R, Richardson J, Scowcroft A, Sunderland T, Rotheram N. Determinants of oral anticoagulation control in new warfarin patients: analysis using data from Clinical Practice Research Datalink. Thromb Res 2015;136(2):250-60.
- Alışır MF, Keçebaş M, Beşli F, Çalışkan S, Güngören F, Yıldırım A, Baran İ, Aydınlar A. Varfarin Kullanan Hastalarda Etkin INR Düzeyi Oranları ve Etiyoloji ile Olan İlişkisi. Turkiye Klinikleri J MedSci 2013; 33:868-73.
- You JH, Chan FW, Wong RS, Cheng G. Is INR between 2.0 and 3.0 the optimal level for Chinese patients on warfarin therapy for moderate-intensity anticoagulation? Br J Clin Pharmacol 2005;59(5):582-7.
- Blackshear JL, Baker VS, Rubino F, Safford R, Lane G, Flipse T at al. Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke prevention in Atrial Fibrilation III Randomised Clinical Trial. The Lancet 1996;348(9028):633-638.
- Pengo V, Zasso A, Barbero F, Banzato A, Nante G, Parissenti L, John N, Noventa F, Dalla Volta S. Effectiveness of fixed mini dose warfarin in the prevention of thrombo embolism and vascular death in non rheumaticatrial fibrillation. Am J Cardiol 1998;82(4):433-7.
- Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, Camm AJ, Weitz JI, Lewis BS, Parkhomenko A, Yamashita T, Antman EM. Comparison of the efficacy and safety of new oral anti coagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014;383(9921):955-62.
- Gurwitz JH, Field TS, Radford MJ, Harrold LR, Becker R, Reed G, DeBellis K, Moldoff J, Verzier N. The safety of warfarin therapy in the nursing home setting. Am J Med 2007;120(6):539-44.
- McCormick D, Gurwitz JH, Goldberg RJ, Becker R, Tate JP, Elwell A, Radford MJ. Prevalence and quality of warfarin use for patients with atrial fibrillation in the long-term care setting. Arch Intern Med 2001;161(20):2458-63.
- Verhovsek M, Motlagh B, Crowther MA, Kennedy C, Dolovich L, Campbell G, Wang L, Papaioannou A. Quality of anti-coagulation and use of warfarin-interacting medications in long-term care: a chart review. BMC Geriatr 2008;8:13
Details
| Primary Language | English |
|---|---|
| Subjects | Patient Safety |
| Journal Section | Research Article |
| Authors | |
| Publication Date | March 29, 2024 |
| Submission Date | January 6, 2024 |
| Acceptance Date | March 7, 2024 |
| Published in Issue | Year 2024Volume: 46 Issue: 1 |
