Dedicated warfarin care programme results in superior warfarin control in Queensland, Australia

Bernaitis, Nijole; Badrick, Tony; Anoopkumar‐Dukie, Shailendra

doi:10.1111/ijcp.13051

Cited by 7 publications

(5 citation statements)

References 37 publications

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“…In this study no statistical difference was found in TTR according to the number of PK interacting medications and, in most cases, the TTR was above 80%. This is a relatively high TTR but consistent with previous research at this warfarin care management program regarding TTR of around 80% [31] with no influence on TTR from concurrent medication [32]. Poor warfarin control has been reported as a reason for changing from warfarin to NOAC therapy but, independent of TTR, the lower risk of intracranial bleeding and haemorrhagic stroke with NOACs may support a decision to switch from warfarin to NOACs [33].…”

Section: Discussionsupporting

confidence: 85%

Comparison of potential pharmacokinetic drug interactions in patients with atrial fibrillation and changing from warfarin to non-vitamin K oral anticoagulant therapy

Bernaitis

Badrick

Anoopkumar‐Dukie

2021

J Thromb Thrombolysis

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Highlights• Proposed benefits of NOACs over warfarin include less drug interactions but increasing evidence suggest pharmacokinetic interactions can impact efficacy and safety of NOACs• Switching patients from warfarin to a NOAC in those with an indication of atrial fibrillation reduced the potential for pharmacokinetic drug interactions but there remained around 40% of patients concurrently taking at least one interacting drug whilst on NOACs• Pharmacokinetic drug interactions with NOACs may be under-recognised and further studies are warranted to determine the correlation with interactions and clinical events so clinical management can be optimised

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Section: Discussionsupporting

confidence: 85%

Comparison of potential pharmacokinetic drug interactions in patients with atrial fibrillation and changing from warfarin to non-vitamin K oral anticoagulant therapy

Bernaitis

Badrick

Anoopkumar‐Dukie

2021

J Thromb Thrombolysis

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“…In this study, the mean TTR was 81% whilst managed by the WCP and 69% whilst managed by the GP. Previous work by this research team compared two models of Australian warfarin management and produced similar results plus further investigated possible factors contributing to the differences in control [23]. Similar to this, recent Australian observational studies have reported warfarin TTR from 69% to 81% [9,24,25] depending on the management model.…”

Section: Discussionsupporting

confidence: 52%

The SAMe-TT2R2 Score Predicts Warfarin Control in an Australian Population with Atrial Fibrillation

Bernaitis

Clark

Kohja

et al. 2019

JCM

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Background: Warfarin requires regular monitoring with the time in therapeutic range (TTR), a common indicator of control and TTR > 70% is indicative of efficient anticoagulation. The SAMe-TT2R2 (sex, age, medical history, treatment, tobacco use, race) model has been utilised as a predictor of warfarin control, with a score ≥ 2 indicative of poor control. However, it has been suggested that race may be over-represented in this model. To date, no Australian studies have applied this model, possibly because race is not routinely recorded. Therefore, the aim of this study was to apply the SAMe-TT2R2 model in an Australian population on warfarin managed by both a warfarin care program (WCP) and general practitioner (GP). Methods: Retrospective data was collected for patients receiving warfarin via a WCP in Queensland and whilst being managed by a GP. Patient data was used to calculate the SAMe-TT2R2 score and the TTR for each patient. Mean TTR was used for analysis and comparison with the categorised SAMe-TT2R2 score. Results: Of the 3911 patients managed by a WCP, there was a significantly lower mean TTR for patients with a SAMe-TT2R2 score ≥ 2 compared to 0–1 (78.6 ± 10.7% vs. 80.9 ± 9.5%, p < 0.0001). Of these patients, 200 were analysed whilst managed by a GP and the categorised SAMe-TT2R2 score did not result in a statistically different mean TTR (69.3 ± 16.3% with 0–1 vs. 63.6 ± 15.0% with ≥2, p = 0.089), but a score ≥2 differentiated patients with a TTR less than 65%. Conclusions: The SAMe-TT2R2 model differentiated Australian patients with reduced warfarin control, despite the exclusion of race. In Australia, the SAMe-TT2R2 score could assist clinicians in identifying Australian patients who may obtain reduced warfarin control and benefit from additional interventions such as a dedicated WCP.

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“…The reduced TTR with aspirin is particularly noteworthy given the high level of warfarin control in this study, namely a mean above 80%. This study was conducted in a dedicated warfarin programme which has been shown to have particularly good warfarin control and levels above other management models, such as by general practitioners, which are more around the standard 70% TTR . A limitation of this study is that sub‐analyses could not be performed in patients with good and poor control as only 13% of patients with no other interacting drugs had a TTR < 70% (data not shown).…”

Section: Discussionmentioning

confidence: 99%

Impact of Aspirin on Warfarin Control as Measured by Time in Therapeutic Range

Boyce

Zayac

Davis

et al. 2018

Basic Clin Pharma Tox

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Dedicated warfarin care programme results in superior warfarin control in Queensland, Australia

Abstract: Australian warfarin control was good when managed by either GP or WCP, but WCP management increased TTR by 13%. Dedicated warfarin programmes can improve warfarin control and optimise therapy for patients.

Cited by 7 publications

References 37 publications

Comparison of potential pharmacokinetic drug interactions in patients with atrial fibrillation and changing from warfarin to non-vitamin K oral anticoagulant therapy

Comparison of potential pharmacokinetic drug interactions in patients with atrial fibrillation and changing from warfarin to non-vitamin K oral anticoagulant therapy

The SAMe-TT2R2 Score Predicts Warfarin Control in an Australian Population with Atrial Fibrillation

Impact of Aspirin on Warfarin Control as Measured by Time in Therapeutic Range

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