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. 2024 Jan;32(1):101906.
doi: 10.1016/j.jsps.2023.101906. Epub 2023 Dec 9.

Appropriateness of anticoagulation level in older adult patients on Warfarin: A multicenter retrospective study

Amal M Badawoud  1 , Abdalrhman Alanizi  1   2 , Adel O Alnakhli  3   4 , Wafa Alzahrani  1 , Hadil S AlThiban  1 , Reema W AlKhurayji  1 , Anwar Mansour Alnakhli  5 , Jawaher Abdullah Alamoudi  5 , Majed S Al Yami  6
Affiliations

Appropriateness of anticoagulation level in older adult patients on Warfarin: A multicenter retrospective study

Amal M Badawoud et al. Saudi Pharm J. 2024 Jan.

Abstract

Warfarin is favored over newer direct oral anticoagulants (DOACs) for many older adults. However, its use necessitates rigorous monitoring due to the fine line between toxic and therapeutic doses. Few studies have evaluated the anticoagulation quality of warfarin among elderly patients in Saudi Arabia. This study aimed to assess and identify factors affecting the anticoagulation quality of warfarin using the time in the therapeutic range (TTR) among older adults attending two hospitals in Saudi Arabia. Additionally, we aimed to evaluate differences in the anticoagulation quality of warfarin when managed by pharmacists or physicians. This cross-sectional study was conducted at King Abdullah bin Abdulaziz University Hospital (KAAUH) and King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia. After calculating the TTR of each patient, the anticoagulation control level was determined using these values: a) good control: >70 %; b) intermediate control: 50-70 %; c) poor control: <50 %. A total of 132 patients prescribed warfarin therapy for different indications were included. Most patients (45.5 %) had poor control with TTRs < 50 %, while 18.2 % had intermediate control, and 36.4 % had good control. Our exploratory findings suggest that having three or more comorbidities was a significant factor associated with a poor TTR [odds ratio (OR) = 3.36; (95 % confidence interval 1.28-8.81); P = 0.014]. Thus, the anticoagulation quality of warfarin among older adult patients was poor in two Saudi Arabian tertiary hospitals, and the number of comorbidities was a potentially poor TTR predictor.

Keywords: Anticoagulant; Atrial fibrillation; Older adults; Saudi Arabia; Time in the therapeutic range; Warfarin.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Forest plot of multivariable logistic regression for predictors of poor TTR.
Fig. 2
Fig. 2
Differences in the risk of bleeding between participants based on different levels of quality of anticoagulation control (TTR).
Fig. 3
Fig. 3
Differences in CHAD2-VASc between participants based on different levels of quality of anticoagulation control (TTR).
Fig. 4
Fig. 4
The difference in anticoagulation level of warfarin (TTR) between participants who were managed by pharmacists and physicians.
See this image and copyright information in PMC

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