Evaluation of effect of frailty on warfarin compliance among older patients

Abstract

Aim: Warfarin has a narrow therapeutic index. We aimed to evaluate the effect of frailty on compliance to warfarin pharmacotherapy and the attainment of international normalised ratio (INR) goals in patients aged over 65 years receiving warfarin. Method: We recruited 473 elderly subjects aged 65 years and over. Indications for the administration of warfarin and INR values were recorded. All patients were assessed according to the Clinical Frailty Scale of the Canadian Health and Aging Study. Whether or not the target of INR values and the degree of frailty were compared. Results: Of the 473 patients aged 65 years and over, 402 patients were assigned to the non-frail group and 71 patients were assigned to the frail group. When patients were compared according to the attainment of target INR values, a negative correlation between frailty and numerical INR values was observed. Conclusion: It can be said that the presence of frailty negatively affects reaching the target INR values in patients over 65 years of age using warfarin. If patients in this population are indicated for warfarin use, it is necessary to be sure that INR monitoring will be done well.

Keywords

• Frailty
• Geriatric population
• International normalised ratio
• Warfarin

References

1. Reference1. Waite SJ, Maitland S, Thomas A, Yarnall AJ. Sarcopenia and frailty in individuals with dementia: A systematic review. Arch Gerontol Geriatr. 2020;92: 104268.
2. Reference2. Nwagwu VC, Cigolle C, Suh T. Reducing Frailty to Promote Healthy Aging. Clin Geriatr Med. 2020;36: 613-630.
3. Reference3. American Medical Association white paper on elderly health. Report of the Council on Scientific Affairs. Arch Intern Med 1990;150: 2459-72.
4. Reference4. Picca A, Calvani R, Cesari M, et al. Biomarkers of Physical Frailty and Sarcopenia: Coming up to the Place? Int J Mol Sci. 2020;21: 5635.
5. Reference5. Nwadiugwu MC. Frailty and the Risk of Polypharmacy in the Older Person: Enabling and Preventative Approaches. J Aging Res. 2020;2020: 6759521.
6. Reference6. Mcdowell I, Hill G, Lindsay J, et al. Canadian Study of Health and Aging Working Group. Disability and frailty among elderly Canadians: a comparison of six surveys. Int Psychogeriatr 2001;13(1): 159-67.
7. Reference7. Krousel-Wood MA, Muntner P, Islam T, Morisky DE, Webber LS. Barriers to and determinants of medication adherence in hypertension: perspective of the cohort study of medication adherence among older adults. Med Clin North Am 2009;93: 753-69.
8. Reference8. Cooney D, Pascuzzi K. Polypharmacy in the elderly: focus on drug interactions and adherence in hypertension. Clin Geriatr Med 2009;25: 221-33.

9. Reference9. Keeling D, Baglin T, Tait C, et al. Guidelines on oral anticoagulation with warfarin - fourth edition. Br J Haematol 2011;154: 311-24.
10. Reference10.Maxwell S. Rational prescribing; the principles of drug selection. Clin Med (Lond) 2009;9: 481-5.
11. Reference11. Ertas F, Duygu H, Acet H, Eren NK, Nazlı C, Ergene AO. Oral antikoagulant use in patients with atrial fibrillation. Turk Kardiol Dern Ars 2009;37: 161-7.
12. Reference12.Cao L, Pokorney SD, Hayden K, Welsh-Bohmer K, Newby LK. Cognitive Function: Is There More to Anticoagulation in Atrial Fibrillation Than Stroke. J Am Heart Assoc. 2015;4: e001573.
13. Reference13. Esengen S, Seckin U, Borman P, Bodur H, Kutsal YG, Yucel M. Drug consumption in a group of elderly residents of a nursing home: relationship to cognitive impairment and disability. J Am Med Dir Assoc. 2000;1: 197-201.
14. Reference14. Torres C, Ciocon JO, Galindo D, Ciocon DG. Clinical approach to urinary incontinence: a comparison between internists and geriatricians. Int Urol Nephrol 2001;33: 549-52.
15. Reference15. Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation). J Am Coll Cardiol. 2006;48: 854-906.
16. Reference16. Pilotto A, Gallina P, Copetti M, et al. Warfarin Treatment and All-Cause Mortality in Community-Dwelling Older Adults with Atrial Fibrillation: A Retrospective Observational Study. J Am Geriatr Soc 2016;64: 1416-24.
17. Reference17. Hylek EM, Go AS, Chang Y, et al. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med 2003;349: 1019-26.
18. Reference18. Singer DE, Albers GW, Dalen JE, Go AS, Halperin JL, Manning WJ. Antithrombotic therapy in atrial fibrillation: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126: 429-456.
19. Reference19. Fang MC, Go AS, Hylek EM, et al. Age and the risk of warfarin-associated hemorrhage: the anticoagulation and risk factors in atrial fibrillation study. J Am Geriatr Soc 2006;54: 1231-6.