Characteristics of patients with thromboembolic disorders on warfarin therapy in resource limited settings
Abstract Background Warfarin is a drug with narrow therapeutic index used in the management of thromboembolic disorders. Several factors affect its plasma concentrations with a resultant risk of toxicity. We examined the database of patients on warfarin therapy in order to establish the factors that...
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| Format: | Article |
| Language: | English |
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BMC
2018-09-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-018-3537-4 |
| _version_ | 1819171258008338432 |
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| author | Zipporah Kamuren Gabriel Kigen Alfred Keter Alice Maritim |
| author_facet | Zipporah Kamuren Gabriel Kigen Alfred Keter Alice Maritim |
| author_sort | Zipporah Kamuren |
| collection | DOAJ |
| description | Abstract Background Warfarin is a drug with narrow therapeutic index used in the management of thromboembolic disorders. Several factors affect its plasma concentrations with a resultant risk of toxicity. We examined the database of patients on warfarin therapy in order to establish the factors that affect the stability of INR and correlated them to clinical outcomes in resource limited settings. Methods We analysed retrospective data of patients admitted to adult medical wards at Moi Teaching and Referral Hospital (MTRH) in 2015. Inclusion criteria were patients with thromboembolic and related disorders and on warfarin treatment. Derived data included demographics, indications for warfarin use, co-prescribed drugs, co-morbidities, INR measurements, duration of hospital stay and clinical outcomes. Descriptive statistics were used to summarize the data. Pearson’s correlation coefficient was used to assess relationships between duration of hospitalization and number of INR tests. Regression splines were used to capture INR trends during the follow up period. Data was analysed using R v. 3.3.1. Results A total of 310 patients had thromboembolic disorders, out of which 63 met the study criteria. The median age was 48 years, while the mean number of INR measurements was once every four days. Majority of patients did not achieve stable INR values, with only two having consecutive INR values within therapeutic goal. Patients who died had high INR levels. The median duration of hospital stay was 9 days (IQR: 7.0, 16.5). There was a significant correlation between length of stay in hospital and the number of times that INR were measured (Corr = 0.667, p < 0.001). The two most common indications for warfarin were DVT (64.4%) and atrial fibrillation (24.7%). All the patients had one or more comorbid conditions except for 11 with DVT alone, with cardiovascular diseases and infections being the most frequent, and on concomitant medications, majority of which are known to interact with warfarin. Conclusions It was difficult to achieve stable INR under the prevailing conditions despite the frequent tests. The potential factors that may have contributed to the fluctuations include drug-drug interactions, frequency of INR tests, comorbidities and the short duration of hospital stay. |
| first_indexed | 2024-12-22T19:48:25Z |
| format | Article |
| id | doaj.art-b862c34da5dd4f04b4e5efe16d5a7204 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-22T19:48:25Z |
| publishDate | 2018-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-b862c34da5dd4f04b4e5efe16d5a72042022-12-21T18:14:37ZengBMCBMC Health Services Research1472-69632018-09-0118111010.1186/s12913-018-3537-4Characteristics of patients with thromboembolic disorders on warfarin therapy in resource limited settingsZipporah Kamuren0Gabriel Kigen1Alfred Keter2Alice Maritim3Department of Pharmacology and Toxicology, Moi University School of MedicineDepartment of Pharmacology and Toxicology, Moi University School of MedicineAcademic Model Providing Access to HealthcareDepartment of Pharmacology and Toxicology, Moi University School of MedicineAbstract Background Warfarin is a drug with narrow therapeutic index used in the management of thromboembolic disorders. Several factors affect its plasma concentrations with a resultant risk of toxicity. We examined the database of patients on warfarin therapy in order to establish the factors that affect the stability of INR and correlated them to clinical outcomes in resource limited settings. Methods We analysed retrospective data of patients admitted to adult medical wards at Moi Teaching and Referral Hospital (MTRH) in 2015. Inclusion criteria were patients with thromboembolic and related disorders and on warfarin treatment. Derived data included demographics, indications for warfarin use, co-prescribed drugs, co-morbidities, INR measurements, duration of hospital stay and clinical outcomes. Descriptive statistics were used to summarize the data. Pearson’s correlation coefficient was used to assess relationships between duration of hospitalization and number of INR tests. Regression splines were used to capture INR trends during the follow up period. Data was analysed using R v. 3.3.1. Results A total of 310 patients had thromboembolic disorders, out of which 63 met the study criteria. The median age was 48 years, while the mean number of INR measurements was once every four days. Majority of patients did not achieve stable INR values, with only two having consecutive INR values within therapeutic goal. Patients who died had high INR levels. The median duration of hospital stay was 9 days (IQR: 7.0, 16.5). There was a significant correlation between length of stay in hospital and the number of times that INR were measured (Corr = 0.667, p < 0.001). The two most common indications for warfarin were DVT (64.4%) and atrial fibrillation (24.7%). All the patients had one or more comorbid conditions except for 11 with DVT alone, with cardiovascular diseases and infections being the most frequent, and on concomitant medications, majority of which are known to interact with warfarin. Conclusions It was difficult to achieve stable INR under the prevailing conditions despite the frequent tests. The potential factors that may have contributed to the fluctuations include drug-drug interactions, frequency of INR tests, comorbidities and the short duration of hospital stay.http://link.springer.com/article/10.1186/s12913-018-3537-4WarfarinInteractionsINR stabilityFactorsOutcomes |
| spellingShingle | Zipporah Kamuren Gabriel Kigen Alfred Keter Alice Maritim Characteristics of patients with thromboembolic disorders on warfarin therapy in resource limited settings BMC Health Services Research Warfarin Interactions INR stability Factors Outcomes |
| title | Characteristics of patients with thromboembolic disorders on warfarin therapy in resource limited settings |
| title_full | Characteristics of patients with thromboembolic disorders on warfarin therapy in resource limited settings |
| title_fullStr | Characteristics of patients with thromboembolic disorders on warfarin therapy in resource limited settings |
| title_full_unstemmed | Characteristics of patients with thromboembolic disorders on warfarin therapy in resource limited settings |
| title_short | Characteristics of patients with thromboembolic disorders on warfarin therapy in resource limited settings |
| title_sort | characteristics of patients with thromboembolic disorders on warfarin therapy in resource limited settings |
| topic | Warfarin Interactions INR stability Factors Outcomes |
| url | http://link.springer.com/article/10.1186/s12913-018-3537-4 |
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