Key result
Multiple non-clinical factors such as female gender, lower education, living alone, smoking, alcohol abuse, fasting, and low body mass index are associated with poor INR control.
Why the study?
Achieving and maintaining the therapeutic INR range remains challenging for patients on warfarin because it is affected by clinical and non-clinical factors.
What non-clinical factors are associated with poor International Normalized Ratio (INR) control in adult patients on warfarin therapy?
What non-clinical factors are associated with poor International Normalized Ratio (INR) control in adult patients on warfarin therapy?
Identifying non-clinical factors such as socio-demographics, smoking, and alcohol use is essential for optimizing INR control and minimizing adverse events in patients on warfarin therapy.
Warfarin is a coumarin derivative oral anticoagulant with a narrow therapeutic international normalized ratio (INR) range. Regular and accurate INR monitoring is essential for optimal anticoagulation management and to reduce the risk of adverse events. However, achieving and maintaining the therapeutic INR range are still a challenge as it is affected by several clinical and non-clinical factors. In this review paper, we analyzed how the non-clinical factors like socio-demographic, modifiable risk and protective factors affect the INR control in patients receiving warfarin therapy. We conducted an extensive literature search in Pubmed, Embase, Scopus and Web of Science for original articles or review papers published from 2016 to 2020. Finally, we included 20 articles in this review which fulfilled the selection criteria. Multiple factors such as female gender, ethnicity difference, lower education level, living alone, activities of daily living dependency, smoking, alcohol abuse, fasting and low body mass index along with poor access to medical facilities are associated with poor INR control. Patient self-management and weight elevation are known to be protective factors against poor INR control. Physicians managing patients on warfarin therapy are encouraged to identify and recognize these factors before prescribing warfarin to achieve and maintain the therapeutic INR.
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Ramasamy et al. (2020) conducted a review in Patients on warfarin therapy. Non-clinical factors (e.g., socio-demographic, modifiable risk factors) was evaluated on International Normalized Ratio (INR) control. Multiple non-clinical factors such as female gender, lower education, living alone, smoking, alcohol abuse, fasting, and low body mass index are associated with poor INR control.
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