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Research
abilo tadesse
University of Gondar
Corresponding Author
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Background
Warfarin is a widely used oral anticoagulant in clinical practice. It is used to prevent arterial emboli in patients with atrial fibrillation, or prevent and treat venous thromboembolism. The efficacy and safety of warfarin depends on maintaining the INR within the therapeutic range. The proportion of time spent in the therapeutic INR range (TTR) is used to evaluate quality of anticoagulation control.
Methods
A hospital-based cross sectional study was conducted between November 1, 2019 and October 31, 2020 at Cardiac and Hematology Clinic, University of Gondar hospital. A consecutive sampling method was used to recruit 338 study subjects. Proportion of time spent in the therapeutic range (TTR) was calculated using the Rosendaal’s linear interpolation method. TTR ≥65% was described as ‘optimal’ International Normalized Ratio (INR) control. The Data were entered into EPI Info version 4.4.1 and transported to SPSS version 20 for analysis. Logistic regression analysis was used to identify associated factors with optimal anticoagulation outcome (TTR ≥65%). P-values <0.05 were used to declare significant association.
Result
A total of 338 study subjects were included in the study. The mean age of patients was 49 years. The majority of study participants attended formal education (79%) and were urban dwellers (57%). Atrial fibrillation was the commonest indication for warfarin therapy. One-third (33%) of study subjects achieved the desired INRs (INR=2.0-3.0), while about one-tenth (13%) of patients attained optimal INR control (TTR≥65%). There were no significant association of socio-demographic characteristics including age, gender, educational level and monthly income with optimal INR control (TTR ≥65%). Likewise, clinical characteristics including dose of warfarin, warfarin adherence, frequency of INR determination, other concomitant drug intake, co-existing comorbidities, consumption of green leafy vegetables and alcohol intake didn’t show significant association with optimal INR control (TTR≥65%).
Conclusion
Institution-based validated protocol might be required to overcome the poor TTR level. ‘Anticoagulation (INR) clinic’ would be required to ‘scale-up’ INR control.
Keywords
Warfarin, INR, TTR, Northwest Ethiopia
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A new preprint design is coming!
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research
abilo tadesse
University of Gondar
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 06 Jan, 2021
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Internal Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Warfarin is a widely used oral anticoagulant in clinical practice. It is used to prevent arterial emboli in patients with atrial fibrillation, or prevent and treat venous thromboembolism. The efficacy and safety of warfarin depends on maintaining the INR within the therapeutic range. The proportion of time spent in the therapeutic INR range (TTR) is used to evaluate quality of anticoagulation control.
Methods
A hospital-based cross sectional study was conducted between November 1, 2019 and October 31, 2020 at Cardiac and Hematology Clinic, University of Gondar hospital. A consecutive sampling method was used to recruit 338 study subjects. Proportion of time spent in the therapeutic range (TTR) was calculated using the Rosendaal’s linear interpolation method. TTR ≥65% was described as ‘optimal’ International Normalized Ratio (INR) control. The Data were entered into EPI Info version 4.4.1 and transported to SPSS version 20 for analysis. Logistic regression analysis was used to identify associated factors with optimal anticoagulation outcome (TTR ≥65%). P-values <0.05 were used to declare significant association.
Result
A total of 338 study subjects were included in the study. The mean age of patients was 49 years. The majority of study participants attended formal education (79%) and were urban dwellers (57%). Atrial fibrillation was the commonest indication for warfarin therapy. One-third (33%) of study subjects achieved the desired INRs (INR=2.0-3.0), while about one-tenth (13%) of patients attained optimal INR control (TTR≥65%). There were no significant association of socio-demographic characteristics including age, gender, educational level and monthly income with optimal INR control (TTR ≥65%). Likewise, clinical characteristics including dose of warfarin, warfarin adherence, frequency of INR determination, other concomitant drug intake, co-existing comorbidities, consumption of green leafy vegetables and alcohol intake didn’t show significant association with optimal INR control (TTR≥65%).
Conclusion
Institution-based validated protocol might be required to overcome the poor TTR level. ‘Anticoagulation (INR) clinic’ would be required to ‘scale-up’ INR control.
Figure 1
Figure 2
Figure 3
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