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

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

doi:10.1007/s11239-018-1719-x

Cited by 9 publications

(9 citation statements)

References 14 publications

(24 reference statements)

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“…Similarly, Wiley et al [30] determined that patients were more willing to switch to an NOAC if satisfaction with warfarin was low. DeCaterina et al [31] found patients switched to NOAC were more often dissatisfied with the OAC treatment, and studies [32,33,34] have also reported between 5 and 13% of patients converting from warfarin to NOAC actually returned to warfarin therapy for reasons including intolerance or bleeds. Further to this, MacLean et al [35] found patient preferences in therapy may depend on their prior experience with the treatment.…”

Section: Discussionmentioning

confidence: 99%

Treatment Expectations, Convenience, and Satisfaction with Anticoagulant Treatment: Perceptions of Patients in South-East Queensland, Australia

Gospos

Bernaitis

2019

JCM

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Background: Warfarin has long been the only oral anticoagulant (OAC) available, but options now include non-vitamin K antagonists. Prescribing an OAC may be influenced by patient factors and preferences influenced by dosing, monitoring, and adverse effects, which may ultimately impact patient satisfaction and convenience. The aim of this study was to explore the perception of OAC treatment by Australian patients in terms of treatment expectations, convenience, and satisfaction. Methods: The Perception of Anticoagulant Treatment Questionnaire was distributed to patients dispensed OAC medication from three pharmacies in South-East Queensland. Responses to questions using a five-point Likert scale were collated and mean results utilised to assess expectations, convenience, and satisfaction, including an analysis across demographic groups. Results: A total of 56 (26.8%) surveys were returned, with the majority of respondent’s male (58.2%). Highest mean scores for treatment expectation were for an OAC that was easy to take (4.85 ± 0.79) and that could be taken care of by the respondents themselves (4.11 ± 1.14). The mean overall score for convenience was 68.90 ± 11.44% and for satisfaction 69.43 ± 16.58%. Significantly higher mean convenience scores were found in females and patients with atrial fibrillation. Conclusions: Patients’ highest expectations were for an OAC that would be easy to take, and overall satisfaction and convenience was around 69%. Factors including demographics can influence perceptions of therapy, and addressing individual preferences for OAC therapy may increase ratings of satisfaction and convenience.

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Section: Discussionmentioning

confidence: 99%

Treatment Expectations, Convenience, and Satisfaction with Anticoagulant Treatment: Perceptions of Patients in South-East Queensland, Australia

Gospos

Bernaitis

2019

JCM

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“…There is still a high frequency of complications resulting from taking antagonists of vitamin K, such as bleeding and an inadequate therapeutic effect of medication due to improper INR control. (1)(2)(3) Informing patients and doctors about the possibilities provided by modern, automatic, portable blood coagulometers will allow improving INR control; and using portable blood coagulometers by means of telemedicine and/or special apps for telephones will also allow improving INR control and decreasing the load on the medical network, resulting in lower public health expenses. (10,11)…”

Section: Discussionmentioning

confidence: 99%

“…In spite of a wide choice of modern, indirect oral anticoagulants that do not require the INR control, Warfarin is still, in some cases, the only medication to prevent thromboembolic complications in pediatrics, in cases of atrial fibrillation of valve etiology, heart valve replacement, and clots in the formed aneurism as a result of an acute myocardial infarction. (1)(2)(3) The history of Warfarin discovery goes back to 1920s, when in North Dakota (USA) the cattle started to die of a fatal-sometimes spontaneous-bleeding after such minor traumas as dehorning or castration. Carrying out the postmortem study of those animals, F. Schofield detected some sweet clover (Melilotus alba and M. officinalis) in the intestine of a dead cow.…”

Section: Introductionmentioning

confidence: 99%

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Increasing Availability of the International Normalized Ratio Control in Russia

Aksyutina¹,

Zograf²,

Mordovsky³

et al. 2018

IJBM

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Background: Warfarin is still, in some cases, the only medication to prevent thromboembolic complications. Warfarin intake imposes regular INR monitoring, which can be performed domiciliary. Currently, in the Russian market, there are two models of automatic portable blood coagulometers: CoaguChek XS (Germany) and qLabs ElectroMeter (China). The main problem of portable coagulometers is their high cost and high cost of operation, which the majority of patients cannot afford. To explore the demand for development of a Russian coagulometer with a more affordable price, a questionnaire survey was carried out among the patients who needed this device. Methods and Results: We surveyed 70 patients taking Warfarin, with 5 years duration paroxysmal, persistent/or stable atrial fibrillation of nonvalvular etiology, having >2 CHADS-VASc score for thrombembolia risk assessment and <3 HAS-BLED score for hemorrhage risk assessment. According to the survey results, 7 (10%) patients had portable coagulometers, including 3 persons with CoaguChek XS and 4 persons with Micropoint qLabs ElectroMeter. Among these patients, there were 4 persons who continued regular INR monitoring domiciliary, while 3 patients had financial difficulties in getting testing strips. At the same time, 14 (20%) patients were not aware of the possibility of domiciliary INR monitoring. Patients who received regular INR monitoring domiciliary with a portable coagulometer, or at their local polyclinics, had neither ischemic strokes nor hemorrhages within a period of five years. Conclusion: It is critical to develop and manufacture a domestic equivalent of a portable coagulometer and testing strips for household use at a more affordable price.

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“…Australian AF guidelines [4] suggest patients with a warfarin TTR < 60% should be considered for NOAC therapy. However, it has also been reported that almost 5% of Australian patients that switch from warfarin to NOACs subsequently revert to warfarin therapy [5]. Therefore, assistance with the decision of the most suitable oral anticoagulant agent and whether a patient can achieve and maintain good warfarin control is critical [6].…”

Section: Introductionmentioning

confidence: 99%

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

Cited by 9 publications

References 14 publications

Treatment Expectations, Convenience, and Satisfaction with Anticoagulant Treatment: Perceptions of Patients in South-East Queensland, Australia

Treatment Expectations, Convenience, and Satisfaction with Anticoagulant Treatment: Perceptions of Patients in South-East Queensland, Australia

Increasing Availability of the International Normalized Ratio Control in Russia

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

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