Anticoagulation Management Practice, and Associated Factors in Atrial Fibrillation Patients on Warfarin Therapy at Saint Paul Hospital Millennium Medical College
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Date
2021-05
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Addis Abeba University
Abstract
Anticoagulants are cornerstones in management of Atrial Fibrillation to prevent stroke.
Monitoring of warfarin depends on time in therapeutic range, frequency of international
normalization range measurements, warfarin dose adjustments, warfarin drug interaction and
bleeding adverse event. This study aimed to assess the anticoagulation management, and factors
affecting anticoagulation management in atrial fibrillation patients taking warfarin. Institutionalbased
Retrospective Cross-Sectional study was conducted from August to October 2019 at St.
Paul Hospital Millennium Medical College. Data were collected retrospectively from a total of
300 patient medical records. Patients who have taken warfarin as an indication of primary
prevention of atrial fibrillation were included in the study. A systematic random sampling
technique was employed while recruiting the study participants. The data were entered to
Statistical Package for Social Science window version 25 for analysis. Descriptive summaries
were presented by using frequencies and percentages. Time in therapeutic range was calculated
using the Rosendaal method, international normalization range frequency and drug interaction
with warfarin were assessed and warfarin dose adjustments were also checked. Univariate and
multivariate analysis were used to determine factors affecting time in therapeutic range and
bleeding events. P-value ≤0.05 was considered as statistically significant. The mean age of the
patient was 56.37 years and 65.3% of the study participants were females. Percent time in
therapeutic range was found to be 42.03 ± 18.75. Only 12.67% patients had a time in the
therapeutic range above 65%. Out of the 3162 INR tests, only 1094(34.60%) tests were within
the therapeutic range. Bleeding event was recorded on 62 (20.70%) of the patients. Poor time in
therapeutic range was associated with only age between 65 and 74, number of comedication of 1
and 2 and presence of congestive heart failure. Anticoagulation management was found to be
poor in this study compared to other studies.
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Keywords
Warfarin, Bleeding, Time in Therapeutic range, Stroke, Atrial Fibrillation