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. 2022 Mar 10;9(2):93-101.
doi: 10.14744/nci.2021.06981. eCollection 2022.

Which is the best for the warfarin monitoring: Following up by fixed or variable physician?

Lale Dinc Asarcikli  1 , Habibe Kafes  2 , Taner Sen  3 , Esra Gucuk Ipek  4 , Osman Beton  5 , Ahmet Temizhan  2 , Mehmet Birhan Yilmaz  5
Affiliations

Which is the best for the warfarin monitoring: Following up by fixed or variable physician?

Lale Dinc Asarcikli et al. North Clin Istanb. .

Abstract

Objective: Warfarin therapy has some difficulties in terms of close monitoring and dosage. This study aims to evaluate the effect of same-fixed versus different-variable physician-based monitoring of warfarin therapy on treatment quality and clinical end-points.

Methods: A total of 625 consecutive patients requiring warfarin treatment were enrolled at seven centers. INR values of the patients measured at each visit and registered to hospital database were recorded. Time in therapeutic range (TTR) was calculated using linear interpolation method (Rosendaal's method). A TTR value of ≥65% was considered as effective warfarin treatment. If a patient was evaluated by the same-fixed physician at each INR visit, was categorized into the same-physician (SP) group. In contrast, if a patient was evaluated by different-variable physicians at each INR visit, was categorized into variable physician (VP) group. Enrolled patients were followed up for bleeding and embolic events.

Results: One hundred and fifty-six patients (24.9%) were followed by SP group, 469 (75.1%) patients were followed by VP group. Median TTR value of the VP group was lower than that of SP group (56.2% vs. 65.1%, respectively, p=0.009). During median 25.5 months (9-36) of follow-up, minor bleeding, major bleeding and cerebral embolic event rates were higher in VP group compared to SP group (p<0.001, p=0.023, p<0.001, respectively). In multivariate analysis, INR monitoring by VP group was found to be an independent predictor of increased risk of bleeding events (OR 2.55, 95% CI 1.64-3.96, p<0.001) and embolism (OR 3.42, 95% CI 1.66-7.04, p=0.001).

Conclusion: INR monitoring by same physician was associated with better TTR and lower rates of adverse events during follow-up. Hence, it is worth encouraging an SP-based outpatient follow-up system at least for where warfarin therapy is the only choice.

Keywords: Anticoagulation; embolism; hemorrhage; international normalized ratio; warfarin.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1.
Figure 1.
Flow chart of study population selection. SP: Same/fixed-physician; VP: Different/variable-physician.
Figure 2.
Figure 2.
Complication rates during follow-up period according to the following physician.
See this image and copyright information in PMC

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