Affiliation:
1. Chulalongkorn University
2. Naresuan University
3. Warfarin Clinic, King Chulalongkorn Memorial Hospital, Thai Red Cross Society
Abstract
AbstractBackground:Atrial fibrillation (AF) is a causing ischemic stroke. Warfarin remains a viable oral anticoagulant for many patients. Time in therapeutic range (TTR) is still not widely applied in clinical practice.Purpose:To study the association of change of TTR after implementation of TTR-INR guided warfarin adjustment protocol in patients with AF receiving warfarin.Methods:This is a prospective study of patients with AF at warfarin clinic of King Chulalongkorn Memorial Hospital. TTR was calculated by using Rosendaal linear interpolation method at baseline, 6 and 12 months after protocol implementation. Patient characteristics and outcomes (TTR improvement, embolic and bleeding events, and mortality) were collected. McNemar’s Chi-square test and paired t-test were used to evaluate the relationship between protocol implementation and outcomes.Results:A total of 57 patients were primary analyzed (mean age of 72 years, 50% females). The TTR at baseline was 65% (53% of patients had TTR less than 65%). After 12 months of protocol implementation, TTR were significantly improved (80%) (p<0.001). Significant improvement of proportion of patients with TTR ³65% was shown after protocol implementation (from 47% to 88%) (p<0.001). Three patients died during the follow-up. No ischemic or major bleeding events were occurred during the follow-up in the first 12 months.Conclusion:The TTR was significantly improved after 12 months of protocol implementation. This strategy may offer additional value in TTR improvement and good outcomes in patients with AF receiving warfarin.
Publisher
Research Square Platform LLC