Quality of warfarin control in atrial fibrillation patients in South East Queensland, Australia

Bernaitis, Nijole; Badrick, Tony; Davey, Andrew K.; Anoopkumar‐Dukie, Shailendra

doi:10.1111/imj.13085

Cited by 18 publications

(16 citation statements)

References 29 publications

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“…However, a previous study of the same warfarin program found a mean TTR of 81% with less than 3% of patients with a TTR<60% [13] suggesting slightly lower control in patients changed to NOAC. Interestingly Pokorney and Granger [14] found data does not support a substantially larger benefit of NOACs in patients with poor warfarin control but found a modest absolute benefit from NOACs in patients naïve to oral anticoagulants.…”

Section: Discussionmentioning

confidence: 81%

Warfarin control in patients transitioning to warfarin after non-vitamin K oral anticoagulant (NOAC) therapy

Bernaitis

Badrick

Davey

et al. 2018

J Thromb Thrombolysis

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Warfarin has long been the most widely prescribed oral anticoagulant. Introduction of non-vitamin K oral anticoagulants (NOACs) has provided anticoagulant options but also presented the potential challenge of transitioning between agents. Changes from NOACs to warfarin are particularly problematic with delays to therapeutic effect and limited real-world data regarding the impact on warfarin control. The aim of this study was to investigate the frequency of switching anticoagulants and the effect on warfarin control. Retrospective data was collected for patients at a warfarin program in Queensland Australia who had exited the program for NOACs plus those who had reverted to warfarin. Data included documented reasons for change and International Normalised Ratio (INR) results with time in therapeutic range (TTR) calculated as a measure of warfarin control. Over 5 years, a total of 3036 patients ceased warfarin to commence a NOAC but 142 (4.7%) reverted to warfarin. Majority of patients (60.6%) reverted to warfarin within 6 months of trialling NOACs with a median of 6 days to therapeutic INR. There was no significant difference in warfarin control before changing to NOACs and after reverting to warfarin (mean TTR 75%) but significantly more frequent testing and lower doses were required to achieve this control. Transitions from warfarin to NOACs results in almost a week to therapeutic effect and warfarin therapy may be further complicated by a need for increased frequency of testing. Further studies are required to refine transition strategies particularly from warfarin to NOAC and minimise potential risks to patients.

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Section: Discussionmentioning

confidence: 81%

Warfarin control in patients transitioning to warfarin after non-vitamin K oral anticoagulant (NOAC) therapy

Bernaitis

Badrick

Davey

et al. 2018

J Thromb Thrombolysis

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“…Further to this, studies from countries with a high quality of warfarin control in general practice have demonstrated no significant change in TTR with dedicated warfarin clinics. Warfarin control in Australia has been reported to be relatively high, with TTRs of 73%‐76% in clinical trial settings and TTRs of 55%to 81% in real‐world practice settings. However, to date, there are no Australian data comparing warfarin management by the GP and dedicated anticoagulant clinics.…”

Section: Discussionmentioning

confidence: 99%

“…Bereznicki et al reported an overall TTR of 64.0% in Australian veterans taking warfarin. Further Australian studies have reported regionally specific TTRs of 69.1% in southern Tasmanian patients, 55.4% in the top end of the Northern Territory, and 79%‐81% in Queensland . Australian approaches for managing patients taking warfarin include care by the GP or by laboratory care programmes .…”

Section: Introductionmentioning

confidence: 99%

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

2018

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“…Nos estudos, o valor do TTR variou de 49,5% a 81% (CELIK et al, 2015;BERNAITIS et al, 2016), e pacientes com hipertensão, doença da artéria coronária, insuficiência cardíaca congestiva ou hábito de fumar apresentaram níveis de TTR significativamente mais baixos do que os demais (CELIK et al, 2015). Assim, o TTR nos pacientes tratados com varfarina foi inversamente associado com a ocorrência de eventos tromboembólicos sistêmicos e de mortalidade (PROIETTI et al, 2016).…”

Section: ____________________________________________________________unclassified

Acompanhamento Farmacoterapêutico De Pacientes Em Uso De Varfarina: Uma Revisão Da Literatura

Colet

Amador

Heineck³

2017

Rev. Cont. Saúde

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RESUMOIntrodução: A varfarina é um dos Anticoagulantes Orais (ACOs) mais utilizados na atenção primária à saúde. Com janela terapêutica estreita, exibe extensa variabilidade de resposta farmacológica e grande suscetibilidade de eventos adversos, como sangramentos e tromboembolismo venoso. Objetivos: realizar uma revisão da literatura sobre o acompanhamento farmacoterapêutico de pacientes ambulatoriais em uso de varfarina. Método: Trata-se de um estudo de revisão. As palavras-chave usadas para a seleção dos artigos foram: Varfarina, Acompanhamento, Farmácia Clínica, Anticoagulantes Orais. Resultados: O uso de varfarina está associado com eventos adversos, sendo mais frequentes as hemorragias, que podem ser prevenidas com monitorização da Razão Normalizada Internacional (INR). A monitorização da coagulação sanguínea é de extrema importância para controlar a eficácia e a adesão do paciente ao tratamento com o anticoagulante. Em um ambulatório multiprofissional para pacientes em tratamento com varfarina identificou-se um aumento do percentual de pacientes com INR na faixa terapêutica com o prolongamento do tempo de acompanhamento no ambulatório. Pacientes atendidos em clínicas de anticoagulação tendem a apresentar mais valores de INR na faixa terapêutica, variando de 60% a 88%. Outro resultado importante relacionado com as clínicas foi a menor frequência de INRs supraterapêuticos e maior tempo na faixa terapêutica. Além disso, o acompanhamento por farmacêutico pode resultar em menores custos de cuidados e de eventos adversos relacionados com a anticoagulação, admissões hospitalares e busca por serviços de emergência. Quando os ACOs são administrados por farmacêuticos, parece haver um tempo mais curto para estabilização da terapia e uma maior percentagem de tempo no intervalo terapêutico, bem como uma diminuição da frequência de erros de medicação, maior tempo na faixa de INR terapêutico e redução das principais interações medicamentosas. ABSTRACT Introduction: Warfarin is one of the most commonly used oral anticoagulants (OACs) in primary health care. With narrow therapeutic window, it exhibits great variability of pharmacological response, and great susceptibility of adverse events, such as bleeding and venous thromboembolism. Objectives: To carry out a review of the literature on pharmacotherapeutic follow-up of outpatients using warfarin. Method: This is a review study. The keywords used for the selection of the articles were: Warfarin, Therapeutic Monitoring, Clinical Pharmacy, Oral Anticoagulants. Results: The use of warfarin is associated with adverse events, with hemorrhages being the most frequent, which can be prevented with INR monitoring. Monitoring of blood coagulation is of paramount importance in controlling patient efficacy and adherence to anticoagulant treatment. In a multiprofessional outpatient clinic for patients receiving warfarin, an increase was observed in the percentage of patients with INR in the therapeutic range, with the prolongation of the follow-up time in the outpatient clinic. Patien...

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Quality of warfarin control in atrial fibrillation patients in South East Queensland, Australia

Cited by 18 publications

References 29 publications

Warfarin control in patients transitioning to warfarin after non-vitamin K oral anticoagulant (NOAC) therapy

Warfarin control in patients transitioning to warfarin after non-vitamin K oral anticoagulant (NOAC) therapy

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

Acompanhamento Farmacoterapêutico De Pacientes Em Uso De Varfarina: Uma Revisão Da Literatura

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