Comparison of Warfarin use in terms of efficacy and safety in two different polyclinics

Abstract

Objective: This study compared the efficacy and safety of warfarin in specialized international normalized ratio (INR) outpatient clinic (INR-C) and in general cardiology outpatient clinic (General-C). Methods: Herein, 381 consecutive patients with a regular follow-up at INR-C (n=233) or General-C (n=148) for at least 1 year were retrospectively included. While INR-C patients were followed by a single experienced trained nurse, General-C patients were followed by a different cardiologist who worked in a rotational principle every month. During controls, demographic characteristics, INR levels, bleeding events, ischemic stroke, and transient ischemic attacks in the last 1 year were recorded. Primary endpoint was defined as the evaluation of the combined major bleeding and ischemic event, and secondary endpoint was defined as the evaluation of them separately. Results: The mean age of the patients was 62±12.86 and 43.8% were male. Mean time in therapeutic range (TTR) level was statistically higher in INR-C than that in General-C (68.8%±15.88 and 51.6%±23.04, respectively; p<0.001). Primary outcomes were significantly higher in General-C than that in INR-C [13.5% (20) and 6.4% (15); respectively, p=0.020]. Overall, major bleeding was observed in 25 patients (6.5%) and (2.6%) ischemic event was observed in 10 patients. In General-C patients, both major bleeding (8.8% vs. 5.2%; p=0.163) and the ischemic event (4.7% vs. 1.3%; p=0.051) were more, and no statistically significant differences were detected between the two clinics. Conclusion: The findings of our study demonstrate that patients followed in INR-C had higher TTR levels and lower bleeding and ischemic events rates that those followed in General-C.

Improving warfarin therapy through implementation of a hospital-based pharmacist managed clinic in Jamaica

“…Active monitoring through specialized anticoagulation clinics have proven beneficial in optimizing warfarin therapy and reducing the risk of complications. 12,13,14,15, 16 In a systematic review published in 2017 of 25 randomized controlled and observational studies of 12,252 patients receiving warfarin therapy, it was shown that anticoagulation status was significantly improved in pharmacist managed outpatient care facilities, including lower bleeding and thromboembolic events. 17…”

The Prevalence and Risks of Inappropriate Combination of Aspirin and Warfarin in Clinical Practice: Results From WARFARIN-TR Study

“…The existence of such significant differences between the two guidelines can lead to physicians having different treatment recommendations for patients with MHV. Besides this difference, the inappropriate use of aspirin with warfarin is frequently among patients who take them concomitantly for any reason as directed by both community-based prescribers and randomized studies (7,8,9,10,11,12). Against this background, the objectives of the present study are to evaluate the prevalence of the inappropriate combination of aspirin and warfarin and to describe which patients are currently receiving combination therapy in daily practice.…”

Eficácia, segurança e preditores de desfechos clínicos dos antagonistas da vitamina K em pacientes com fibrilação atrial valvar e não valvar

“…Dado semelhante foi encontrado por Kiliç e colaboradores em estudo que avaliou a eficácia e segurança da varfarina em clínicas da Turquia, que encontrou como preditores independentes desses desfechos, a história de sangramento prévio e controle do RNI realizado por clínicas generalistas com TFT inferior a 50% 99 .…”