Predictive factors for obtaining a correct therapeutic range using antivitamin K anticoagulants: a tertiary center experience of patient adherence to anticoagulant therapy
Authors JurcuĆŁ R, Militaru S, Geavlete O, DrÄgotoiuN, SipoĆ S, RoĆulescu R, GinghinÄ C, JurcuĆŁ C
Received 21 April 2015
Accepted for publication 19 June 2015
Published 8 September 2015 Volume 2015:9 Pages 1271—1278
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Johnny Chen
Ruxandra JurcuĆŁ,1 Sebastian Militaru,1 Oliviana Geavlete,1 Nic DrÄgotoiu,1 Sergiu SipoĆ,1 RÄzvan RoĆulescu,2 Carmen GinghinÄ,1 Ciprian JurcuĆŁ2
1Prof Dr CC Iliescu Emergency Institute for Cardiovascular Diseases, University of Medicine and Pharmacy, 2Dr Carol Davila Central University Emergency Military Hospital, Bucharest, Romania
Background: Patient adherence is an essential factor in obtaining efficient oral anticoagulation using vitamin K antagonists (VKAs), a situation with a narrow therapeutic window. Therefore, patient education and awareness are crucial for good management. Auditing the current situation would help to identify the magnitude of the problem and to build tailored education programs for these patients.
Methods: This study included 68 hospitalized chronically anticoagulated patients (mean age 62.6±13.1 years; males, 46%) who responded to a 26-item questionnaire to assess their knowledge on VKA therapy management. Laboratory and clinical data were used to determine the international normalized ratio (INR) at admission, as well as to calculate CHA2DS2-VASC and HAS-BLED scores for patients with atrial fibrillation.
Results: The majority of patients (62%) were receiving VKA for atrial fibrillation, the others for a mechanical prosthesis and previous thromboembolic disease or stroke. In the atrial fibrillation group, the mean CHA2DS2-VASC score was 3.1±1.5, while the average HAS-BLED score was 1.8±1.2. More than half of the patients (53%) had an INR outside of the therapeutic range at admission, with the majority (43%) having a low INR. A correct INR value was predicted by education level (higher education) and the diagnostic indication (patients with mechanical prosthesis being best managed). Patients presenting with a therapeutic INR had a trend toward longer treatment duration than those outside the therapeutic range (62±72 months versus 36±35 months, respectively, P=0.06). There was no correlation between INR at admission and the patient’s living conditions, INR monitoring frequency, and bleeding history.
Conclusion: In a tertiary cardiology center, more than half of patients receiving VKAs are admitted with an INR falling outside the therapeutic range, irrespective of the bleeding or embolic risk. Patients with a mechanical prosthesis and complex antithrombotic regimens appear to be the most careful with INR monitoring, especially if they have a higher level of education. Identifying patient groups with the lowest time interval spent in the therapeutic range could help attending physicians educate patients focusing on specific awareness issues.
Keywords: anticoagulant therapy, antivitamin K agents, patient adherence, questionnaire
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