Varfarin Kullanan Hastalarda TTR' nin Etkinliği: Atriyal Fibrilasyon ve Mekanik Kalp Kapak Hastalarında TTR ile HASBLED ve CHA2DS2-VASc Skorları Arasındaki İlişki

Öz

AMAÇ: Varfarin, dünya genelinde en yaygın kullanılan antikoagülandır. Valvüler atriyal fibrilasyon (AF) ve/veya mekanik kalp kapağı olan hastalar için tek seçenek olup, terapötik aralıkta geçen zaman (Time in therapeutic range-TTR) tedavi etkinliği açısından kritik öneme sahiptir. Bu çalışmada, varfarin kullanan AF ve/veya mekanik kalp kapağı olan hastalarda düşük TTR' nin öngörücülerini ve TTR ile HASBLED, CHA2DS2-VASc skorları arasındaki ilişki araştırıldı. GEREÇ VE YÖNTEM: Ankara Eğitim ve Araştırma Hastanesi Kardiyoloji polikliniğine başvuran, 6 aydan daha uzun süredir varfarin kullanan, en az 4 INR değerine ulaşılabilen 18 yaş ve üstü 209 hasta çalışmaya dahil edildi. Rosendaal yöntemi kullanılarak hesaplanan TTR değerine göre hastalar efektif TTR (>%60) ve inefektif TTR (≤%60) olarak iki gruba ayrıldı. CHA2DS2-VASc ve HASBLED skorları hesaplanarak gruplar arasında karşılaştırmalar yapıldı. BULGULAR: Hastaların TTR ortalaması %54,18 ± 27,91 olup, 96 hasta efektif, 113 hasta ise inefektif TTR aralığındaydı. İnefektif TTR grubunda, efektif TTR grubuyla karşılaştırıldığında kalp yetersizliği [23 (%71,9) ve 9 (%28,1) p=0,028] ve polifarmasi [70 (%60,3) ve 46 (%39,7) p=0,042] oranları daha yüksekti. Ayrıca, HASBLED skorunun inefektif TTR grubunda daha yüksek olduğu gözlendi [tüm hastalar için 2,46(1.33), i̇nefektif TTR 3,13 (1,16), efektif TTR 1,67 (1,06), (p<0,001)]. CHA2DS2-VASc skoru ile TTR arasında anlamlı bir ilişki bulunamadı. SONUÇ: Çalışmamızda, HASBLED skoru yüksek olan hastalarda düşük TTR oranları ile güçlü bir ilişki tespit edildi. Varfarin kullanan hastalarda TTR' nin düşüklüğü komplikasyon riskini artırmaktadır. HASBLED skorunun artışı ile inefektif TTR arasındaki ilişki, varfarin tedavisinin etkinliğini değerlendirmek için klinik pratikte önemli bir parametre olabileceğini göstermektedir. Yüksek risk grubundaki hastaların daha sıkı takip edilmesi ve risk faktörlerinin azaltılması gerekmektedir. Sonuç olarak, HASBLED, hem kanama riskini hem de varfarin kontrolünü değerlendiren önemli bir araç olarak kullanılabilir.

Anahtar Kelimeler

• Atriyal Fibrilasyon
• CHA2DS2-VASc Skoru
• HASBLED
• Terapötik Aralıkta Geçen Zaman
• Varfarin

Effectiveness of TTR in Patients Using Warfarin: Relationship Between TTR and HASBLED and CHA2DS2-VASc Scores in Patients with Atrial Fibrillation and Mechanical Heart Valves

Öz

Warfarin is the most widely used anticoagulant worldwide. It is the only option for patients with valvular atrial fibrillation (AF) and/or prosthetic mechanical heart valves, and the time in therapeutic range (TTR) is crucial for treatment efficacy. This study investigated the predictors of low TTR and the relationship between TTR and HASBLED, CHA2DS2-VASc scores in patients with AF and/or mechanical heart valves using warfarin. MATERIAL AND METHOD: The study included 209 patients aged 18 and over who had been using warfarin for more than 6 months, with at least 4 INR values available, presenting to the Cardiology outpatient clinic of Ankara Training and Research Hospital. Based on the TTR value calculated using the Rosendaal method, patients were divided into two groups: effective TTR (>%60) and ineffective TTR (≤%60). CHA2DS2-VASc and HASBLED scores were calculated and compared between the groups. RESULTS: The average TTR of the patients was 54.18 ± 27.91%, with 96 patients in the effective TTR group and 113 in the ineffective TTR group. The ineffective TTR group had higher rates of heart failure [23 (71.9%) vs. 9 (28.1%), p=0.028] and polypharmacy [70 (60.3%) vs. 46 (39.7%), p=0.042] compared to the effective TTR group. Additionally, the HASBLED score was higher in the ineffective TTR group (p<0.001). No significant relationship was found between the CHA2DS2-VASc score and TTR. CONCLUSİON: In our study, a strong relationship was found between high HASBLED scores and low TTR rates. Low TTR in patients using warfarin increases the risk of complications. The relationship between increased HASBLED scores and ineffective TTR suggests that HASBLED could be an important parameter for assessing the efficacy of warfarin treatment in clinical practice. Patients in the high-risk group should be closely monitored and risk factors minimized. Consequently, HASBLED can be used as an important tool for evaluating both bleeding risk and warfarin control.

Anahtar Kelimeler

• atrial fibrillation
• CHA2DS2-VASc Score
• HASBLED Score
• Time in Therapeutic Range
• warfarin

Kaynakça

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