Among patients with atrial fibrillation prescribed warfarin, 44.5% had subtherapeutic, 36.5% therapeutic, and 18.9% supratherapeutic INR levels upon hospital arrival.
Observational (n=375)
No
What is the adequacy of anticoagulation in patients with atrial fibrillation prescribed warfarin presenting to a hospital?
Nearly half of patients with atrial fibrillation prescribed warfarin present to the hospital with subtherapeutic INR levels, leaving them inadequately protected against thromboembolism.
STUDY OBJECTIVE: To evaluate the adequacy of anticoagulation in patients with atrial fibrillation (AF) coming to a hospital. DESIGN: Retrospective medical record review. SETTING: Tertiary care hospital. PATIENTS: Consecutive patients with a history of AF who had been prescribed warfarin and who had the international normalized ratio (INR) measured when they arrived at the hospital. Those who developed AF as a complication during hospitalization were excluded. MEASUREMENTS AND MAIN RESULTS: Of 1085 patients, 375 (mean age 73 yrs, 56.3% men) were eligible for further evaluation. Most had nonvalvular AF; in 44.5% the INR was subtherapeutic, in 36.5% it was therapeutic, and in 18.9% it was supratherapeutic. Patients admitted for any thromboembolic event and for ischemic stroke were significantly more likely to have subtherapeutic INRs. CONCLUSION: It is well documented in the literature that warfarin is underprescribed, but our results suggest that even in treated patients, about half are inadequately protected from thromboembolism.
Bungard et al. (Fri,) conducted a observational in Atrial fibrillation (n=375). Warfarin was evaluated on Adequacy of anticoagulation (INR levels). Among patients with atrial fibrillation prescribed warfarin, 44.5% had subtherapeutic, 36.5% therapeutic, and 18.9% supratherapeutic INR levels upon hospital arrival.
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