Abstract
In the treatment of warfarin anticoagulation, reduction of thromboembolic events must be evaluated with the risk of bleeding. Time in therapeutic range (TTR) by the method of Rosendaal aluated with the risk of bleeding. Time in therapeutic range (TTR) by the method of Rosendaal is a tool that values quality monitoring anticoagulant therapy and correlates with the presence of thromboembolic events or bleeding. In this study time therapeutic range (TTR), factors associated with lower (TTR) and adverse effects presented in the anticoagulation clinic are presented. Methods and Results: A descriptive cross-sectional study from 1° January 2011 and 29th February 2012.2232 results of INR of 319 patients were assessed. 98550 days follow up. 44% (108) were men, 66% (211) women, average age 60.3 years, seven average visits / year, warfarin weekly dose of 29.8 mg. The weekly dose has an inverse relationship with age; in patients under 45 years 37.9 mg., and in patients over 75 years, 22.1 mg. The TTR increased from 48 to 54%, respectively. Indications for anticoagulation: atrial fibrillation (AF) 38% (121), venous thromboembolic disease (VTE) 35% (112), prosthetic valves (PV) 17.5% (56) and emboli or arterial thrombosis (EA) 9.5% (30). 228 patients (71%) had a TTR average of 64%. (40-100), INR greater than 5 in 2.24% and INR less than 1.5 in 10.9%. Minor bleeding: 16 patients (5%), major bleeding occurred in two patients (0.65%) and one adverse event of embolism (0.32%). The factors associated with low TTR were male gender, venous thromboembolic disease, use of generic warfarin, age less than 55 years, time shorter than one year and less than five visits. Conclusions: TTR is a useful measurement to establish the efficacy of anticoagulant therapy with warfarin. The goal of a 60% TTR ensures fewer adverse effects from bleeding or thrombosis. A low number of visits and anticoagulation less than a year are associated with low TTR.
Highlights
Minor bleeding: 16 patients (5%), major bleeding occurred in two patients (0.65%) and one adverse event of embolism (0.32%)
The factors associated with low therapeutic range (TTR) were male gender, venous thromboembolic disease, use of generic warfarin, age less than 55 years, time shorter than one year and less than five visits
TTR is a useful measurement to establish the efficacy of anticoagulant therapy with warfarin
Summary
El tiempo de rango terapéutico (TRT) por el método de Rosendaal es una herramienta que valora la calidad en la monitorización de la terapia anticoagulante y se correlaciona con presencia de eventos tromboembólicos o sangrados. En este estudio se describe el tiempo de rango terapéutico (TRTR), los factores relacionados con menor (TRTR) y los efectos adversos presentados en la clínica de anticoagulación. Los factores asociados a un TRTR bajo fueron: sexo masculino, enfermedad tromboembólica venosa, uso de warfarina genérica, edad menor de 55 años, tiempo menor de un año y menos de cinco visitas. La meta de 60% en tiempo de rango terapéutico garantiza menos efectos adversos por sangrado o trombosis. Palabras clave: clínica de anticoagulación, método de Rosendaal, warfarina, tiempo en rango terapéutico
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