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Thanh Tam Quach Hiep, Christian Creveuil, Sophie de Jaecher

    Annales De Biologie Clinique
    |June 29, 2022
    PubMed
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    Vitamin K antagonists (VKAs) like fluindione and warfarin are common in primary care. Warfarin showed a trend towards more stable anticoagulation and longer intervals between International Normalized Ratio (INR) monitoring compared to fluindione.

    Area of Science:

    • Pharmacology
    • Clinical Medicine
    • Medical Research

    Background:

    • Vitamin K antagonists (VKAs) are frequently prescribed in primary care, often after direct oral anticoagulants.
    • Fluindione dominates VKA prescriptions in France (82% in 2016), contrasting with warfarin's global prevalence.
    • Warfarin's longer half-life suggests potential for more stable anticoagulation and International Normalized Ratio (INR) control.

    Purpose of the Study:

    • To compare the long-term anticoagulant effect stability of fluindione versus warfarin.
    • To assess and compare the frequency of INR monitoring for patients on fluindione versus warfarin.
    • To evaluate the clinical implications of VKA choice on patient outcomes and quality of life.

    Main Methods:

    • Retrospective exposed/non-exposed study using data from a medical biology laboratory.

    Related Experiment Videos

  • Inclusion of adult patients treated with fluindione or warfarin between January 1, 2014, and December 31, 2016.
  • Assessment of anticoagulant stability via time in therapeutic range (TTR) using the Rosendaal method and INR data; statistical analysis included multi-level linear regression.

    • Main Results:

    • A total of 204 patients were included: 170 on fluindione and 34 on warfarin.
    • Mean TTR was 68.0% for fluindione versus 72.0% for warfarin (p=0.085), indicating a trend towards better stability with warfarin.
    • Mean interval between INR tests was significantly shorter for fluindione (22.8 days) compared to warfarin (31.1 days) (p=0.049).

    Conclusions:

    • Warfarin may offer a quality of life benefit for patients compared to fluindione due to potentially more stable anticoagulation.
    • Despite fluindione's current prevalence in France, warfarin appears to be a preferable option in primary care settings.
    • Further research may be warranted to confirm warfarin's advantages in terms of INR stability and patient well-being.