Warfarin adherence and anticoagulation control in atrial fibrillation patients: a systematic review

This paper aims to review the literature systematically on warfarin adherence in patients with atrial fibrillation and to assess the anticoagulation control focused on patient clinical outcomes. Atrial Fibrillation (AF) is a cardiac disease defined by abnormal heart rhythm, which significantly impacts a patient's health status, quality of life, and heart output, and thus a greater risk of stroke and hospitalization. Most AF patients should be managed with long-term anticoagulation, either with vitamin K antagonists such as warfarin or new oral anticoagulants (NOACs). Anticoagulants have been a core in treating AF and weighing the consequences of thrombosis with the risk of bleeding. This systematic review aimed to assess the impact of warfarin adherence on AF patients.

A systematic search of the literature was conducted on electronic databases of PubMed/MEDLINE, EBSCO, Cochrane library, Google, and Google Scholar from January 2011 to April 2021 to determine studies that reported warfarin adherence on patients with atrial fibrillation.

Out of 1429 titles and abstracts were retrieved, 12 studies fulfilled and met the inclusion criteria. From the included studies, two were carried out in Brazil and one from the following nations: Libya, Jordan, Iran, KSA, Canada, Malaysia, Bahrain, UAE, Singapore, and the USA. The study designs identified were cross-section, retrospective, and prospective studies. Warfarin adherence was influenced by multiple causes, including pharmaceutical services, the number of medications, and warfarin knowledge regarding anticoagulation control. Warfarin adherence illustrates its positive association with TTR and INR as a measure of anticoagulation control.

While the available evidence is limited, this systematic review demonstrated a positive finding of the association between warfarin adherence and anticoagulation control in patients with AF.