Abstract
Abstract Purpose: The purpose of the study was to assess the quality of anticoagulation with warfarin in patients with non-valvular AF who were managed exclusively in pharmacy run anticoagulation clinics and to evaluate whether these patients would be expected to have the same efficacy and safety profiles as those patients in the RE-LY, ROCKET AF, and ARISTOTLE trials. Methods: This was a retrospective study of 146 patients in 3 pharmacy run anticoagulation clinics who were initiated on anticoagulation with warfarin therapy to prevent stroke associated with atrial fibrillation. International Normalized Ratio (INR) values were collected over a 1-year period and the quality of management was expressed as time in therapeutic range (TTR) calculated by Rosendaal’s linear interpolation method. Results: Forty-six patients from university internal medicine (UIM) clinic, 9 patients from family medicine (FM) clinic, and 91 patients from pharmacotherapy (PCT) clinic were studied. During the 1-year period, the overall mean TTR was 61.1%. The mean TTR in the UIM clinic, the FM clinic, and the PCT clinic was 60.1%, 62.5%, and 61.5%, respectively. Conclusion: The quality of anticoagulation with warfarin, as assessed by TTR, in the 3 pharmacy run anticoagulation clinics was similar to the mean TTR values reported for the warfarin-treated patients in the RE-LY, ROCKET-AF, and ARISTOTLE trials. The results of these studies are applicable to our patient population.
Highlights
One of the major complications associated with atrial fibrillation (AF) is stroke, accounting for approximately 10-15% of all ischemic strokes in patients greater than 65 years of age and approximately 25% of all ischemic strokes in patients greater than 80 years of age [1]
A total of 146 patients were identified for inclusion, of which 46 patients were from the university internal medicine (UIM) clinic, 9 patients were from the family medicine (FM) clinic, and 91 patients were from the pharmacotherapy (PCT) clinic
The mean percentage of time patients spent within the target International Normalized Ratio (INR) range of 2 to 3 was 61.1%, with little variation by clinics (60.1% for the UIM clinic, 62.5% for the FM clinic, and 61.5% for the PCT clinic) (Figure 1)
Summary
One of the major complications associated with atrial fibrillation (AF) is stroke, accounting for approximately 10-15% of all ischemic strokes in patients greater than 65 years of age and approximately 25% of all ischemic strokes in patients greater than 80 years of age [1]. It can be prevented by lifelong use of oral anticoagulation therapy. Three new oral anticoagulation therapies have been compared to warfarin in large phase III clinical trials These include the oral direct thrombin inhibitor, dabigatran etexilate and the two oral Factor Xa inhibitors, rivaroxaban and apixaban. Dabigatran, rivaroxaban, and apixaban have been FDA approved for stroke prophylaxis in patients with atrial fibrillation
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