Time in therapeutic range values of patients using warfarin and factors that influence time in therapeutic range [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2021; 49(6): 463-473 | DOI: 10.5543/tkda.2021.21015

Time in therapeutic range values of patients using warfarin and factors that influence time in therapeutic range

Lale Dinç Asarcıklı1, Habibe Kafes2, Taner Şen3, Esra Gucuk İpek4, Muhammet Cebeci5, Murat Gül6, Selçuk Kanat7, Ahmet Temizhan2
1Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, İstanbul, Turkey
2Department of Cardiology, Health Sciences University Ankara City Hospital, Ankara, Turkey
3Department of Cardiology, Dumlupınar University School of Medicine, University Hospital, Kütahya, Turkey
4Department of Cardiology, Polatlı State Hospital, Ankara, Turkey
5Department of Cardiology, Söke State Hospital, Aydın, Turkey
6Department of Cardiology, Aksaray University School of Medicine, Aksaray, Turkey
7Department of Cardiology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey


OBJECTIVE
The time in therapeutic range (TTR) of international normalized ratio (INR) is essential for the safety and efficacy of warfarin treatment. In this study, we aimed to determine TTR and the factors that affect TTR in patients using warfarin.

METHODS
Patients taking warfarin for valvular and nonvalvular atrial fibrillation (AF) or prosthetic heart valves who were admitted to our cardiology outpatient clinic were enrolled. TTR was calculated using the linear interpolation method. The patients were analyzed according to warfarin indications and TTR efficiency (TTR ≥60%). Weekly warfarin dose, the duration of warfarin use, the frequency of INR visits per year, and the awareness of patients regarding target INR were noted.

RESULTS
The TTR of 248 patients (aged 57.21±12.45 years, 33.1% male) was 55.92±27.84%, and 48.0% patients exhibited efficient TTR. Clinical and demographic characteristics (age, sex, socioeconomic status, and comorbidities) exerted no effect on TTR and TTR efficiency. The frequency of INR visits per year was 10.02±3.80. TTR was related to the frequency of annual INR visits (r=0.131, p=0.039). Only one-third (30.2%) of patients were aware of their target INR. The literacy of the patients and duration of warfarin use exerted a positive effect on awareness (p=0.011 and p=0.024, respectively).

CONCLUSION
The findings of our study demonstrated that TTR and TTR efficiency were low and not associated with the characteristics of patients or indications. Unfortunately, in patients with valvular AF and prosthetic valves, warfarin is the sole drug that can be used. Thus, awareness and knowledge regarding target INR are essential to overcome poor anticoagulation monitoring with frequent INR visits.


How to cite this article
Lale Dinç Asarcıklı, Habibe Kafes, Taner Şen, Esra Gucuk İpek, Muhammet Cebeci, Murat Gül, Selçuk Kanat, Ahmet Temizhan. Time in therapeutic range values of patients using warfarin and factors that influence time in therapeutic range. Turk Kardiyol Dern Ars. 2021; 49(6): 463-473

Corresponding Author: Lale Dinç Asarcıklı, Türkiye
© Copyright 2021 Archives of the Turkish Society of Cardiology
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