Serkan ŞAHİN, İshak ŞAN, Tuğba ATMACA TEMREL

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

Amaç: Varfarin kullanan hastalar, acil durumları olduğunda acil servislere başvururlar. Varfarin kullanan bir hasta acil servise başvurduğundaolası 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 anketçalışmasıdır. 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.

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

Objectives: Patients using warfarin, are also referred to emergency departments when they have anemergency. When a patient using warfarin presented to the emergency departments to be able toestimate the possible level of International Normalized Ratio can help in making an emergencytreatment plan. The purpose of this study was to demonstrate patient success in maintainingInternational Normalized Ratio by investigating spot International Normalized Ratio levels of patientsusing warfarin who were admitted to emergency services.Materials and Methods: Our study is survey study. Among 2071 patients, 129 patients using warfarindue to non‐valvular causes who were admitted to the emergency departments for warfarin‐unrelatedreasons and who met the inclusion criteria were included in the study.Results: 41.80% of the participants had International Normalized Ratio values within the therapeuticrange. It was shown that warfarin‐related bad experiences and having training did not affect whetherInternational Normalized Ratio was within the therapeutic range or not.Conclusion: Patients using warfarin are unsuccessful in maintaining their target InternationalNormalized Ratio levels. New policies and programs should be developed to protect the targetInternational Normalized Ratio levels.

PDF

___

1. 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)
2. 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)
3. Funk DM. Coagulation assays and anticoagulant monitoring. American Society of Hematology, Hematology (2012) 460‐5
4. Wen MS, Lee MM. Warfarin Pharmacogenetics: New Life for an Old Drug. Acta Cardiol Sin 2013;29:235‐42
5. 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)
6. 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
7. 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)
8. 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)
9. 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)
10. 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)
11. 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)
12. 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)
13. 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)
14. 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)
15. 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)
16. 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 )
17. 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.
18. 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
19. 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)
20. 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
21. 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)
22. 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.)
23. 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 )
24. 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.