Abstract:
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Background
Warfarin is a commonly used medication with a narrow therapeutic
index. The initiation of warfarin requires consideration of a variety of
factors, which include reviewing the indications and contraindications for
this agent, performing a thorough clinical assessment along with a riskbenefit
analysis for anticoagulation, consideration of warfarin
pharmacology, developing strategies to monitor the intensity of
anticoagulation and for the detection of adverse events, and education of the
patient.
Design:
Descriptive prospective cross sectional study.
Setting:
This study held at the cardiac surgery and renal transplant center
in Ahmed Ghasim Hospital.
Objectives:
The different factors which affect proper warfarin control the
level of knowledge,and the degree of control in one hundred patient were
assessed
Methodology:
Patient knowledge about the warfarin dose, the time of
administration, the effect of diet, drug interaction with warfarin and the
incidence of complication were studied using a direct questionnaire and the
last INR was measured to identify the level of control.
Results:
The results were compared to the results of a similar Sudanese
study which was conducted at 2000 in the same hospital in the same number
IV
of patients. In our study 38% of the patients were properly controlled having
an INR within the therapeutic range, in contrast to the previous study when
the number is 34%, 20% of our patients had good level of education
regarding warfarin, compared to 16% in the previous study .60% of our
patients did not received any education programme about warfarin, 71.4% of
them were educated after starting the therapy. 60% of the patients were
taking different medication with different interaction with warfarin.88% of
the patients knew the different interaction of warfarin with different types of
diet.70% of the population studied live far from the center outside Khartoum
state. Only 2 of our patients were provided with the warfarin booklets, and
they obtained it from another hospital, in the previous study 12 of the
patients had the booklet and they obtained it from abroad. 36% of our
patients suffered from bleeding, the commonest site was epistaxis, 36.2%
from them had bleeding for several times, compared to12% in the previous
study this reflects the bad control as 33% of our patients had prolonged INR,
compared to one patient in the previous study. Only 2 of our patients
suffered from one attack of cerebral thrombosis in the form of
cerebrovascular accident. School education did not seem to affect warfarin
control since in both educated and illiterate patients, the percentage of those
who had controlled INR are similar. The optimum maintainace dose was
found to be 3-5mg.
Conclusion:
From this study it was concluded after 10 years that more than
half of the patients were not well controlled having an INR outside the
therapeutic range, the most significant causes of poor control were lack of
full education about the drug and the far residence from hospital and
laboratories and the high cost of the INR investigation. Bleeding endangered
a large number of our patients life. Thrombosis still seemed to be a rare
complication. |