Abstract
Objective: Selection of oral anticoagulants (OACs) in patients with thromboembolic diseases is complex and equivocal in nature, owing majorly to the non-adherence to standard clinical guidelines. Moreover, there is a scarcity of data on utilisation pattern of OACs in Indian population. Our primary objective was to analyse the prescribing pattern of OACs among in-patients with thromboembolic disorders. The secondary objective was to determine the significant predictors that affect their utilisation pattern.Methods: This prospective observational study examined the clinical data over 6 mo from in-patients on oral anticoagulation with warfarin and acenocoumarol. Patients were recruited into 2 study groups: coronary artery disease (CAD) and non-CAD to analyse the prescription pattern. Potential predictors of utilisation pattern were evaluated for significance with logistic regression analysis for CAD group.Results: Prescription analysis highlights preference of acenocoumarol (72.4%) over warfarin among 232 in-patients in the study. Lack of achievement of target international normalised ratio (INR) levels was noticed in 74.2% of the study population. 57.8% of cases belonged to CAD group (males 76.7%; mean age 59.4±13.5 y). Valvular heart disease (VHD) was the significant predictor (p =0.001) of warfarin utilisation among CAD patients while male gender, heart failure (HF) and arrhythmia were significant for acenocoumarol.Conclusion: Predominance of age<60 y and male gender was observed in the study. Acenocoumarol was preferred over warfarin in all the in-patient departments. VHD, male gender, HF and arrhythmia significantly affected the OAC utilisation.
Highlights
Anticoagulants (AC) are vital lifesaving drugs used to prevent as well as treat arterial, venous and intra-cardiac thromboembolic events [1]
Lack of achievement of target international normalised ratio (INR) levels was noticed in 74.2% of the study population. 57.8% of cases belonged to coronary artery disease (CAD) group
Valvular heart disease (VHD) was the significant predictor (p =0.001) of warfarin utilisation among CAD patients while male gender, heart failure (HF) and arrhythmia were significant for acenocoumarol
Summary
Anticoagulants (AC) are vital lifesaving drugs used to prevent as well as treat arterial, venous and intra-cardiac thromboembolic events [1]. As per the Global burden of disease study in India, coronary artery disease (CAD) is the main cause of cardiovascular diseases (CVDs) accounting for 35% of the disease burden [2]. The pharmacotherapy with the oral anticoagulants (OACs) are recommended for long-term thromboprophylaxis in patients at high risk of thrombotic complications. OACs are observed to reduce the risk of atrial fibrillation (AF) complicating to stroke up to two thirds [3]. In India, the vitamin K antagonists (VKAs; warfarin and acenocoumarol) are the most prevalent choices, in spite of their narrow therapeutic index and interindividual treatment response variability, majorly due to the ease developed by the physicians after years of its usage. The dosage tapering and individualization of dose are vital for VKAs [4, 5]
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