310: Level of knowledge among Tunisian patients undergoing long-term acenocoumarol treatment: results of ARACOP (ARiana Avk Control Program)

Abstract

Oral anticoagulation with vitamin K antagonists (VKA) are widely prescribed for the prophylaxis and treatment of many thrombo-embolic disorders. The management of patients with VKA represents a public health problem according to higher number of death and hospitalization in relation to bleeding complications. To evaluate patients’ knowledge about the acenocumarol treatment, the therapeutic range of International Normalized Ratio (INR), the bleeding and thrombotic risks and its interactions with other medications and food. 139 consecutives patients on long-term acenocumarol treatment were included in this single center descriptive study. The mean age was 58.9±14 (26–86 years) and 50.4% were male. They were interviewed by a fellow using a questionnaire specifically prepared by the authors. This questionnaire had 10 questions concerned their understanding of the goal of the oral anticoagulant therapy, knowledge of target INR ratio, frequency of INR examination, factors influencing INR values e.g. drugs-drugs interactions (like aspirin therapy) and food. One point was giving for each question answered correctly. The mean total knowledge level was 3.9±2.5 (0–10). Percentages of correct answers (Level test score>6/10) for the questions evaluating know-ledge about acenocoumarol treatment did not exceed 18%. Only 23 patients (16.5%) declared knowledge of target INR ratio and only 52 (37.4%) answered correctly about the bleeding risk. The knowledge of interactions between acenocoumarol and other medications in particular aspirin was low (28.6%). The importance of diet was unknown by almost patients (95.5%). Multivariate analysis showed two independent predictor factors linked with an insufficient knowledge (Level test score<4/10): age>60 years (OR=4.7; p<0.001) and an educational level less than elementary school (OR=3.7; p=0.01). Level of patients’ knowledge about the oral anticoagulant treatment was very low among our outpatients. So, it seems very appropriate to develop special anticoagulant clinics in Tunisia.