Evaluation of Warfarin Use in Cardiac Clinic Outpatients

Norisca A. Putriana, Taofik Rusdiana, Tina Rostinawati, Mohammad R. Akbar, Dika P. Destiani

Abstract


The use of warfarin was monitored using the International Normalized Ratio (INR) value. This study aims to determine the relationship between the patient’s demographic variables and INR, as well as the therapy result and differences in their INR value. A cross-sectional study was used with retrospective observational data collected by tracing secondary information of medical records from outpatients with heart disease on warfarin therapy at Dr. Hasan Sadikin hospital Bandung between 2016 to 2020. Subsequently, the difference in patients’ INR value was analyzed with the Mann-Whitney test based on dosage. At the same time, the relationship between demographic variables and INR was examined using the Chi-square test and Spearman correlation. The INR examination results in 192 subjects showed 124 patients (64.6%) reached the target with an average value of 2.37 ± 0.21 and a warfarin dose of 19.31 ± 6.25 mg weekly, while 68 (35.4%) had an average of 1.82 ± 0.73 and a dose of 20.24 ± 6.24 mg weekly. Subsequently, the difference test with Mann Whitney (p = 0.004) showed a variation in the INR value based on the warfarin dose. The Spearman correlation analysis results indicated a relationship between BMI (p = 0.009), daily (0.010), and weekly dose (0.008) on the INR value with the correlation coefficient of 0.188; 0.186; and 0.192;  indicating a negative association with very weak correlation strength. This study showed that a majority of patients reached the INR value of 2-3, and the demographic variables associated with this ratio were BMI and warfarin dose. The decision to increase and decrease the warfarin dose is determined by INR value and BMI.


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References


World Health Organization. Cardiovascular Disease 2020. https://www.who.int/health-topics/cardiovascular-diseases/#tab=tab_1 (accessed on 7 September 2020)

Ministry of Health Republic of Indonesia. Riset Kesehatan Dasar (Riskesdas) 2018, Indonesian Health Research and Development Agency, Jakarta 2018.

Nutescu EA, Shapiro NL, Ibrahim S, West P. Warfarin and Its Interaction with Foods, Herbs, and Other Dietary Supplements. Expert Opinion on Drug Safety. 2006;5 (3): 433-451.

Pellagatti T, Ternelli M, Frascio D, Bettini R. Warfarin Personalized Dosage: Re-compounding for a More Suitable Therapy and Better Compliance. International Journal of Pharmaceutical Compounding. 2017; 21 (3): 247-250.

Galus AS, Baker RI, Chong BH, Ockelford PA. Consensus Guidelines for Warfarin Therapy. The Medical Journal of Australia. 2000; 172 (12): 600-605.

Johnson JA. Warfarin Pharmacogenetics: A Rising Tide for Its Clinical Value. Circulation. 2012; 125 (16): 1964-1966.

Urbonas G, Valius L, Sakalyte G, Petniunas K, Petniuniene I. The Quality of Anticoagulant Therapy Among Warfarin-Treated Patients with Atrial Fibrillation in a Primary Health Care Setting. Medicina. 2019; 55 (15): 1-11.

Shuaib W, Iftikhar H, Alweis R, Shahid H. Warfarin Therapy: Survey of Patients Knowledge of Their Drug Regimen. Malaysian Journal of Medical Sciences. 2014; 21 (4): 37-41.

Putriana NA, Lestari K, Diantini A, Rusdiana T. Warfarin Therapy Monitoring of Cardiac Care Patients in Hospital in Bandung. Jurnal Farmasi Klinik Indonesia. 2012; 1 (3): 110-116.

Megawati S, Lestari T, Setyani WL. Evaluation of The Use Warfarin Oral on The INR Value of The Pathway Patients RSU of Kabupaten Tangerang in 2018. Farmagazine. 2019; 6 (2): 10-16.

Kasinathan G, Pairan S, Rowther S, Sulaiman S, Basimin SA, Samsuni N, Balasegar V. Efficacy of Point-of-Care Testing (POCT) in Reducing Total Waiting Time at Warfarin Clinic of a District Hospital: A Cohort Study. Open Access Library Journal. 2016; 3 (2): 1-7.

Mansur AP, Takada JY, Avakian SD, Strunz CMC. Warfarin Dose for Anticoagulation Therapy in Elderly Patients with Chronic Atrial Fibrillation. Clinics. 2012; 67 (6): 543-546.

Furdiyanti NH, Pramantara IDP, Wahyono D. Evaluation of Warfarin Dosing and Its Clinical Outcome in Outpatients. Jurnal Manajemen dan Pelayanan Farmasi. 2014; 4 (3): 175-179.

Putriana NA, Barliana MI, Lestari K. The Influence of Pharmacist’s Counseling on Knowledge and Perception on Cardiac Patient Warfarin Management at Dr. Hasan Sadikin Hospital Bandung. Jurnal Farmasi Klinik Indonesia. 2017; 6 (4): 282-289.

Baker JW, Pierce KL, Ryals CA. INR Goal Attainment and Oral Anticoagulation Knowledge of Patients Enrolled in an Anticoagulation Clinic in a Veterans Affairs Medical Center. The Journal of Managed Care and Specialty Pharmacy. 2011; 17 (2): 133-42.

Park R, Koo SM, Hwang MO, Seo DC, Kim KU, Uh ST, Kim YK. Feasibility of Warfarin Anticoagulation Management with a Patient Self-Testing Model in Korea. Clinical and Experimental Thrombosis and Hemostatis. 2015; 2 (1): 8-10.

Wallace JL, Reaves AB, Tolley EA, Oliphant CS, Hutchison L, Alabdan NA, et al. Comparison of Initial Warfarin Response in Obese Patients Versus Non-Obese Patients. Journal of Thrombosis and Thrombolysis. 2013; 36: 96-101.

Yin T, Miyata T. Warfarin Dose and The Pharmacogenomic of CYP2C9 and VKORC1 Rational and Perspective. Thrombosis Research. 2007; 120 (1): 1-10.

Njovane XW, Fasinu PS, Rosenkranz B. Comparative Evaluation of Warfarin Utilisation in Two Primary Healthcare Clinics in The Cape Town Area. Cardiovascular Journal of Africa. 2013; 24 (2): 19-23.

White PJ. Patient Factors That Influence Warfarin Dose Response. Journal of Pharmacy Practice. 2010; 23 (3): 194-204.

Holbrook AM, Pereira JA, Labiris R, McDonald H, Douketis JD, Crowther M, Wells PS. Systematic Overview of Warfarin and Its Drug and Food Interactions. Archive of Internal Medicine. 2005; 165 (10): 1095-106.

Whitely HP, Fermo JD, Chumney EC, et al. Effect of Patient-Specific Factors on Weekly Warfarin Dose. Ther Clin Risk Manag. 2007; 3 (3): 499-504.

Mueller JA, Patel T, Halawa A, Dumitrascu A, Dawson NL. Warfarin Dosing and Body Mass Index. Annals of Pharmacology. 2014; 48 (5): 584-588.

Ogunsua AA, Touray S, Lui JK, Ip T, Escobar JV, Gore J. Body Mass Index Predicts Major Bleeding Risks in Patients on Warfarin. Journal of Thrombosis and Trombolysis. 2015; 40 (4): 494-498.

Khairunnisa D, Sari IP, Gofir A. The Corelation Between Dose and Duration in Warfarin Administration Against INR (International Normalized Ratio) Target 1,5-2,0 on Ischemic Stroke Patient with Atrial Fibrilation. Jurnal Manajemen dan Pelayanan Farmasi. 2013; 3 (4): 269-272.

Yoshizawa M, Hayashi H, Tashiro Y, Sakawa S, Moriwari H, Akimoto T, et al. Effect of VKORC1-1639 DNA Polymorphism, Body Weight, Age, and Serum Albumin Alterations on Warfarin Response in Japanese Patients. Thrombosis Research. 2009; 124 (2): 161-166.




DOI: https://doi.org/10.15416/pcpr.v7i1.39666

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