What Is The Success Rate of Patients Using Warfarin In Maintaining Their Target International Normalized Ratio Levels?

Year 2019, , 366 - 374, 28.06.2019

Tuğba Atmaca Temrel , Serkan Şahin İshak Şan

https://doi.org/10.17098/amj.577304

Cited By: 1

Abstract

Objectives:
Patients using warfarin, are also referred to emergency departments when they
have an emergency. When a patient using warfarin presented to the emergency
departments to be able to estimate the possible level of International Normalized Ratio can help in making an emergency
treatment plan. The purpose of this study was to demonstrate patient success in
maintaining International Normalized Ratio by
investigating spot International Normalized Ratio
levels of patients using warfarin who were admitted to emergency services.

Materials and
Methods: Our study is survey study. Among 2071 patients, 129
patients using warfarin due to non-valvular causes who were admitted to the
emergency departments for warfarin-unrelated reasons and who met the inclusion
criteria were included in the study.

Results: 41.80%
of the participants had International Normalized
Ratio values within the therapeutic range. It was shown that
warfarin-related bad experiences and having training did not affect whether
International Normalized Ratio was within the
therapeutic range or not.

Conclusion:
Patients using warfarin are unsuccessful in maintaining their target
International Normalized Ratio levels. New
policies and programs should be developed to protect the target International Normalized Ratio levels.

Keywords

Warfarin, international normalized ratio, emergency medicine

Varfarin Kullanan Hastaların Hedef Uluslararası Normalleştirilmiş Oran Başarısı ne Kadar İyi?

Abstract

Amaç: Varfarin kullanan hastalar, acil durumları olduğunda acil
servislere başvururlar. Varfarin kullanan bir hasta acil servise
başvurduğunda  olası Uluslararası
Normalize Oran düzeyini tahmin edebilmek acil tedavi planının yapılmasına
yardımcı olabilir. Bu çalışmada acile başvuran ve varfarin kullanan hastaların
o anki spot Uluslararası Normalize Oran düzeyleri incelenerek hastaların Uluslararası
Normalize Oran kontrolündeki başarılarının gösterilmesi amaçlandı.

Materyal ve Metot: Çalışmamız bir anket  çalışmasıdır. 2071 hastadan non valvüler
nedenli varfarin kullanan, varfarin ilişkisiz bir nedenden dolayı acil servise
başvuran ve dahil etme kriterlerini karşılayan 129 hasta çalışmaya kabul
edildi.

Bulgular: Katılımcıların % 41,80’inin Uluslararası
Normalize Oran’ı terapotik aralıktaydı. Uluslararası Normalize Oranın terapotik
aralıkta olup olmamasında varfarin ilişkili kötü tecrübelerin ve eğitim almış
olmanın etkisinin olmadığı gösterildi.

Sonuç: Hastalar hedef Uluslararası Normalize Oran düzeylerini
korumada başarısızdır. Hedef Uluslararası Normalize Oranı korumak için yeni politikalar
ve programlar geliştirilmelidir.

Keywords

Varfarin, uluslararası normalleştirilmiş oran, acil servis

References

• Joppa SA, Salciccioli J, Adamski J, Patel S, Wysokinski W, McBane R. Review A Practical Review of the Emerging Direct Anticoagulants, Laboratory Monitoring. Reversal Agents, J. Clin. Med. 2018, 7, 29 (doi:10.3390/jcm7020029)
• Levine M, Pizon AF, Padilla-Jones A, Ruha, AM. Warfarin Overdose: A 25-Year Experience. J. Med. Toxicol. (2014) 10:156–164 (doi: 10.1007/s13181-013-0378-8)
• Funk DM. Coagulation assays and anticoagulant monitoring. American Society of Hematology, Hematology (2012) 460-5
• Wen MS, Lee MM. Warfarin Pharmacogenetics: New Life for an Old Drug. Acta Cardiol Sin 2013;29:235-42
• 5-Garcia DA, Crowther M. Reversal of Warfarin Case-Based Practice Recommendations. Circulation 2012 Jun 12;125(23):2944-7. (doi:10.1161/CIRCULATIONAHA.111.081489)
• Holbrook A, Schulman S, Witt DM et al. Evidence-Based Management of Anticoagulant Therapy Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012; 141(2)(Suppl):e152S–e184S
• Keeling D, Baglin T, Tait C et al. Guidelines on oral anticoagulation with warfarin – fourth Edition. British Journal of Haematology, 2011;154(3):311–24 (doi:10.1111/j.1365- 2141.2011.08753.x)
• Rolfe S, Papadopoulos S, Cabral PK. Controversies of Anticoagulation Reversal in Life-Threatening Bleeds. Journal of Pharmacy Practice 23(3):217-25 (doi: 10.1177/0897190010362168)
• Pirmohamed M. Warfarin: almost 60 years old and still causing problems. British Journal of Clinical Pharmacology 2006; 62: 509-11 (doi:10.1111/j.1365-2125.2006.02806.x)
• Farinola N, Caughey GE, Bell JS, Johns S, Hauta-aho M, Shakib S. Influence of stroke and bleeding risk on prescribing of oral anticoagulants in older in patients; has the availability of direct oral anticoagulants changed prescribing? Therapeutic Advances in Drug Safety, 2018; 9(2): 113–21 (doi: 10.1177/2042098617747835)
• Gokcal E, Pasi M, Fisher M, Gurol ME. Atrial Fibrillation for the Neurologist: Preventing both Ischemic and Hemorrhagic Strokes. Current Neurology and Neuroscience Reports 2018; 18(2):6 (https://doi.org/10.1007/s11910-018-0813-y)
• Smith DE, Xuereb CB, Pattison HM, Lip GYH, Lane D. STRial of an Educational intervention on patients' knowledge of Atrial fibrillation and anticoagulant therapy, INR control, and outcome of Treatment with warfarin (TREAT). BMC Cardiovascular Disorders 2010; 10:21 (http://www.biomedcentral.com/1471-2261/10/21)
• Roskell NS, Samuel M, Noack H, Monz BU. Major bleeding in patients with atrial fibrillation receiving vitamin K antagonists: a systematic review of randomized and observational studies. Europace 2013; 15: 787–97 (doi:10.1093/europace/eut001)
• Yu HY, Lin MH, Lin LY, Wang CH, Chi NH, Chen YS. Do Patients With High CHA2DS2-VASc Scores Need High Intensity of Anticoagulants After Valve Surgery? Circ J 2018;82(4):1186-94 (doi: 10.1253/circj.CJ-17-1172)
• Boulanger L, Kim J, Friedman M, Hauch O, Foster T, Menzin J. Patterns of use of antithrombotic therapy and quality of anticoagulation among patients with non-valvular atrial fibrillation in clinical practice. Int J Clin Pract, March 2006;60(3):258–64 (doi : 10.1111/ j.1368-5031. 2005 .00790 .x)
• Sayhan MB, Oğuz S, Yüksel V, Hüseyin S, Sayhan ES, Yağcı G. The Analysis of Patients Admitted to the Emergency Department Due to Complications Related to Warfarin Treatment. JAEM 2014; 13: 194-8( doi: 10.5152/jaem.2014.075 )
• Hylek EM, Go AS, Chang Y, et al. Effect of Intensity of Oral Anticoagulation on Stroke Severity and Mortality in Atrial Fibrillation. The New England Journal of Medicine, N Engl J Med 2003;349:1019-26.
• Hylek EM, Evans-Molina C, Shea C, Henault LE, Regan S. Major Hemorrhage and Tolerability of Warfarin in the First Year of Therapy Among Elderly Patients With Atrial Fibrillation. Circulation 2007;115:2689-96
• Green L, Tan J, Morris JK, et al. A three-year prospective study of the presentation and clinical outcomes of major bleeding episodes associated with oral anticoagulant use in the UK (ORANGE study). Haematologica. 2018;103:1-18 (doi:10.3324/haematol.2017.182220)
• Stafford L, Tienen EC, Bereznicki L, Peterson GM. The benefits of pharmacist-delivered warfarin education in the home. International Journal of Pharmacy Practice 2012; 20:384–9
• Newall F, Monagle P, Johnston L. Patient understanding of warfarin therapy: A review of education strategies. Hematology, 2005;10(6):437-42 (doi:10.1080/10245330500276451)
• Heneghan CJ, Garcia-Alamino JM, Spencer EA, et al.Self-monitoring and self-management of oral anticoagulation. Cochrane Database of Systematic Reviews 2016;7 (doi: 10.1002/14651858.CD003839.pub3.)
• Jenner KM, Simmons BJ, Delate T, Clark NP, Kurz D, Witt DM. An Education Program for Patient Self-Management of Warfarin. Perm J 2015;19(4):33-8 (http://dx.doi.org/10.7812/TPP/14-246 )
• Dar T, Yarlagadda B, Vacek J, Dawn B, Lakkireddy D. Management of Stroke Risk in Atrial Fibrillation Patients with Bleeding on Oral Anticoagulation Therapy-Role of Left Atrial Appendage Closure, Octreotide and more. Journal of Atrial Fibrillation 2017; 10(4):1729.