Author/Authors :
cekirdekci, elif ijlal university of girne - faculty of medicine - department of cardiology, Girne, Cyprus
Abstract :
Objective: The safety and effectiveness of warfarin therapy is associated with the quality of anticoagulation control, which is often assessed by using the percentage time in therapeutic range (TTR). This study aimed to evaluate the variation in INR and TTR between individual and center- based measurements and to observe how this variation affects the effectiveness of oral anticoagulant therapy. Materials and Methods: A total of 237 patients were selected in the current study. Patients were divided into two groups: The routine care group consisted of 179 subjects (75 men, with a median of 61 years), and the self-management group included of 58 age and sex- matched individuals (26 men, with a median of 64 years). Results: The patients in self-management group had significantly higher levels of TTR (77 (63, 89) % vs. 46 (15, 75)), but the time below range (%) and the time above range (%) were significantly lower than routine-care group (9 (0, 23) vs. 29 (15, 49), P 0.001, 12 (0, 23) vs. 20 (8, 44), P=0.006, respectively). Heart failure (HF) (3.281, 95% CI 1.561 -6.897, P=0.002), renal dysfunction (3.754, 95% CI 1.224-11.519, P=0.021), younger age ( 65 years) (2.786, P=0.004), CHA2DS2-VASc (1.339, P=0.010), and routine-care management (8.113, P 0.001 were the independent predictors of having lower TTR. Conclusion: Self-management strategy has good outcomes in terms of prevention of major thromboembolic and bleeding complications. The home testing devices may provide better management of being safe for long-term oral anticoagulation.
