Evaluation of Quality of Anticoagulation Therapy Among Neurological Patients: An Institutional Based Study
DOI:
https://doi.org/10.21276/4fxp9y04Keywords:
Oral anticoagulation, thromboembolic events- atrial fibrillation, Nicoumalon, Stroke, WarfarinAbstract
Background: Oral anticoagulation (OAC) is used in neurology practice for primary and secondary stroke prevention in atrial fibrillation (AF), prosthetic mechanical valve; dilated cardiomyopathy (DCMP) and cerebral venous sinus thrombosis (CVST). This study evaluates the quality of oral anticoagulation therapy in neurology patients.
Methods: Patients attending neurology service in KPC Medical College and Hospital, Jadavpur, Kolkata, West Benga (India); who were prescribed oral anticoagulant (OAC) were included. The international normalized ratio (INR) values of the patients who were already on OAC were analyzed. The level of anticoagulation, factors interfering with OAC and complications were noted.
Results: Total 90 patients were included in study with median age 35±10 years. Ten were excluded as follow up was not done properly. Final study involves 80 patients. Fifty-eight patients received OAC for stroke prevention, 17 for cerebral venous sinus thrombosis (CVST) and 5 for deep vein thrombosis (DVT). Follow up was done for 2 years. Of the total 947 INR reports, 362 were below and 231 were above the therapeutic level. Stable INR was obtained in 36 patients only. INR level was improved by dose adjustment in 25 patients, and dietary adjustment in eight patients. Five patients were sensitive and three were resistant to OAC. Complications were noted in 14 instances.
Conclusions: Stable therapeutic INR is difficult to maintain in neurological patients. However, modification of diet, drug and dose of oral anticoagulant may help in stabilization of INR. The findings support the need for educational interventions to improve the knowledge regarding OAT and, thereby, prevention of stroke.
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References
McGrath ER, Kapral MK, Fang J, Eikelboom JW, O'Conghaile A, Canavan M, et al. Association of atrial fibrillation with mortality and disability after ischemic stroke. Neurology. 2013;81:825-32
Roy D, Talajic M, Nattel S, Wyse DG, Dorian P, Lee KL, et al. Rhythm control versus rate control for atrial fibrillation and heart failure. N Engl J Med. 2008;358:2667-77.
Ensley J Lensing AW, Cogo A, Cuppini S, Villalta S, Carta M, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med. 1996;125:1-7.
De Schryver EL, Algra A, Kappelle LJ, van Gijn J, Koudstaal PJ. Vitamin K antagonists versus antiplatelet therapy after transient ischaemic attack or minor ischaemic stroke of presumed arterial origin.
Paciaroni M, Agnelli G, Micheli S, Caso V. Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke:Stroke. 2007;38:423-30.
Granger CB Calleja s, de la Vega V, Lahoz CH. Oral anticoagulation in elderly patients as secondary prevention of cardioembolic strokes. Int Arch Med. 2010;3:8.
Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ. Antithrombotic therapy and prevention of thrombosis panel, 9th ed. Evidence-based clinical practice guidelines. Chest 2012;141:7S-47S.
Cheruku R, Tapazoglou E, Ensley J, et al. The incidence and significance of thromboembolic complications Pharmacology and management of the vitamin K antagonists: Evidence-based clinical practice guidelines, 8th ed. 1991;68:2621
Heneghan C, Perera R, Roberts N, Hollowell J, Glasziou P, et al. Anticoagulation control and prediction of adverse events in patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes. 2008;1:84-91.
Puthiyaveetil ,N KE. Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation. Stroke Prevention in Atrial Fibrillation II Study. Lancet. 1994;343:687-91.
Marini C, De Santis F, Sacco S, Russo T, Olivieri L, Totaro R, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke. 2005;36:1115-9.
Apostolakis S, Benavente L, Sullivan RM, Olshansky B, Lip GY. Factors affecting quality of anticoagulation control among patients with atrial fibrillation on warfarin: the SAMe-TT2R2 score. Chest. 2013;144:1555-63.
Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest. 2010;137:263-72
John M, Kuriakose KM,. Pattern of oral anticoagulant use following prosthetic heart Valve replacement. Indian J Thorac Cardiovasc Surg. 2011;27:119-24.
Singh P, Kalita J, Misra UK. Quality of anticoagulation therapy in neurological patients in a tertiary care hospital in north India. Indian J Med Res. 2016;143:428-33
Coccheri S, Poggi M, Manotti C Briët E. Optimal oral anticoagulant therapy in patients with mechanical heart valves. N Engl J Med. 1995;333:11-7.
Quinn L, Landefeld CS Study on complications of oral anticoagulant therapy (ISCOAT) Lancet. 1996;348:423-8.
Marini C, De Santis F, Sacco S, Russo T, Olivieri L, Totaro R, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke. 2005;36:1115-9
Baglin T, Tait C, Watson H, Perry D, Baglin C, et al. Therauptic INR level study inBrazil and Guidelines on oral anticoagulation with warfarin - fourth edition. Br J Haematol. 2011;154:311-24.
Horstkotte D, Piper C, Wiemer M. Optimal frequency of patient monitoring and intensity of oral anticoagulation therapy in valvular heart disease. J Thromb Thrombolysis. 1998;1:19-24.
Sawicki PT. A structured teaching and self-management program for patients receiving oral anticoagulation. JAMA. 1999;281:145-50. 12. Kakkar N, Kaur R, Outpatient oral anticoagulant management: audit of 82 patients. J Assoc Phyicians India. 2005;53:847-52.
Baglin T, Tait C, Watson H, Perry D, Baglin C, et al. Therauptic INR level study inBrazil and Guidelines on oral anticoagulation with warfarin - fourth edition. Br J Haematol. 2011;154:311-24.
Azar AJ, Deckers JW, Rosendaal FR, van Bergen PF, van der Meer FJ, Jonker JJ, et al. Assessment of therapeutic quality control in a long-term anticoagulant trial in post-myocardial infarction patients. Thromb Haemost. 1994;72:347-51.
Manotti C, Pini M, Quintavalla R, Dettori AG. A comparative study on the quality of oral anticoagulant therapy (warfarin versus acenocoumarol) Thromb Haemost. 1994;71:188-91.
Witt DM, Delate T, Clark NP, Martell C, Tran T, Crowther MA, et al. Twelve-month outcomes and predictors of very stable INR control in prevalent warfarin users. J Thromb Haemost. 2010;8:744
Eikelboom J, Flaker G, Commerford P, Franzosi MG, et al. Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of INR control achieved by centres and countries as measured by time in therapeutic range. Circulation. 2008;118:2029-37.
Jauch EC, Saver JL, Adams HPJ, Bruno A, Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of INR control achieved by centres and countries as measured by time in therapeutic range. Circulation. 2008;118:2029-37.
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