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Quality control of oral anticoagulation with vitamin K antagonists in primary care patients in Poland: a multi-centre
Jolanta Sawicka-Powierza1, Krzysztof Buczkowski, Sławomir Chlabicz
1Department of Family Medicine, Department of Haematology, Medical University of Bialystok, Poland. jolasawicka@gmail.com.
Background:
Vitamin K antagonists (VKAs) remain the mainstay of anticoagulation therapy, which requires monitoring of international normalised ratio (INR). Quality of oral anticoagulation, clinical benefits, and the risk related to VKA use are determined by the time in therapeutic range (TTR).
Aim:
The aim of this study was to assess the therapeutic quality of oral anticoagulation and to determine the factors that affect the incidence of INR outside the recommended range in primary care patients undergoing long-term VKA therapy in Poland.
Methods:
A multi-centre cross-sectional analysis was carried out in 15 general practices from three voivodeships of Poland. At the planned time, INRs measured closest to the designated date in all patients were assessed in terms of being within the therapeutic range. TTR was determined as the percentage of visits with INR in therapeutic range on a given date.
Results:
Overall, 430 patients aged 70.3 ± 12.7 years (222 men aged 72 ± 12.8 years and 208 women aged 68.5 ± 12.4 years) were included in the study. In the groups with INR below, within, and above therapeutic range, the patients' age was 67.3 ± 13.4, 72 ± 12, and 70.5 ± 13 years (p = 0.001), respectively. TTR for all the participants was 55%. Statistically significant factors associated with INRs outside the therapeutic range were: age below 60 years (compared to older persons; p = 0.003), more or less frequent INR control compared to the recommended intervals of four to eight weeks (p < 0.001), and the type of the VKA used, i.e. acenocoumarol compared to warfarin (p < 0.001). Logarithmic regression analysis showed that the use of acenocoumarol compared to warfarin, increased the chances of INRs below therapeutic range (odds ratio [OR] 3.19; 95% confidence interval [Cl] 1.65-6.16), while male sex increased the probability of INR being above this range (OR 2.01; 95% Cl 1.12- 3.59).
Conclusions:
The TTR in primary care patients on VKA therapy was 55%. Better quality of oral anticoagulation with VKA could be achieved by using warfarin instead of acenocoumarol, proper INR monitoring in the recommended interval of four to eight weeks, and tighter INR control in younger and male patients.
Insights
Achieving optimal anticoagulation quality in patients on Vitamin K antagonists (VKAs) requires careful monitoring. Warfarin use, regular INR checks, and tailored management for younger, male patients can improve time in therapeutic range (TTR).
Area of Science:
- Cardiology
- Pharmacology
- Primary Care Medicine
Background:
- Vitamin K antagonists (VKAs) are crucial for anticoagulation, necessitating International Normalized Ratio (INR) monitoring.
- Time in Therapeutic Range (TTR) dictates the efficacy and safety of VKA therapy.
Purpose of the Study:
- To evaluate the quality of oral anticoagulation in Polish primary care patients on long-term VKA therapy.
- To identify factors influencing INR deviations from the recommended range.
Main Methods:
- A multi-center, cross-sectional study involving 430 patients across 15 general practices in Poland.
- INR values were assessed to determine TTR, defined as the percentage of visits with INR within the therapeutic range.
- Statistical analysis, including logarithmic regression, identified factors associated with out-of-range INRs.
Main Results:
- The overall TTR was 55%.
- Factors linked to INRs outside the therapeutic range included age under 60, infrequent INR monitoring (outside 4-8 week intervals), and use of acenocoumarol over warfarin.
- Acenocoumarol increased the risk of sub-therapeutic INRs (OR 3.19), while male sex increased the risk of supra-therapeutic INRs (OR 2.01).
Conclusions:
- The study found a TTR of 55% in Polish primary care patients on VKA therapy.
- Optimizing anticoagulation quality involves preferring warfarin over acenocoumarol, adhering to 4-8 week INR monitoring intervals, and closer management of younger and male patients.
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