Key result
COVID-19 pandemic linked to ~9 percentage-point drop in patients achieving optimal TTR.
Why the study?
The study was conducted to investigate the short-term effect of the COVID-19 pandemic on the management of warfarin therapy used for AF and prosthetic valve disease.
Does the COVID-19 pandemic reduce time in therapeutic range and INR monitoring adherence in patients on warfarin therapy?
Cohort (n=312)
No
Does the COVID-19 pandemic reduce time in therapeutic range and INR monitoring adherence in patients on warfarin therapy?
The COVID-19 pandemic significantly disrupted routine INR monitoring for patients on warfarin, leading to poorer time in therapeutic range, which may predispose patients to thromboembolic and bleeding complications.
Pandemic-linked TTR declines and INR non-adherence in warfarin users warrant monitoring caution during disruptions; leaves open resilient strategies for future crises.
Aim The aim of this study was to investigate the short-term effect of the COVID-19 pandemic on the management of warfarin therapy used for atrial fibrillation (AF) and prosthetic valve disease.Material and methods The study included 139 Atrial fibrillation (AF) patients and 173 prosthetic valve patients (PVP) who were using warfarin. The time in therapeutic range (TTR), International Normalized Ratio (INR) averages, the numbers of INR tests, and the non-adherence to INR monitoring (NIM) were compared for the pre-covid period (PCP) and the COVID-19 period (CP). Also, adherence to warfarin therapy was evaluated with a questionnaire.Results For all patients, the INR values were higher in the CP (2.47 vs 2.60, p<0.001), and the NIM percentage was higher (19.2 % vs 71.5 %, p<0.001) in the CP. The number of INR tests was lower during the CP (p<0.001).The percentage of patients with TTR≥70 % was lower during the CP (41.7 % vs 33 % p=0.017). Subgroup analysis showed that for PVP, TTR values and the percentage of patients with TTR ≥70 % were similar in both the PCP and CP periods. The questionnaire showed that for 94.1 % of respondents, the major cause of NIM in the CP was the COVID-19 pandemic. However, during the CP, adherence to warfarin medication was high (95.5 %).Conclusion Lower TTR during the COVID-19 pandemic can increase bleeding and thromboembolic cases.Therefore, patients taking warfarin should be followed more closely, and more practical ways should be considered for INR testing.
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Doğan et al. (2021) conducted a cohort in Atrial fibrillation and prosthetic valve disease (n=312). COVID-19 pandemic vs. Pre-COVID period was evaluated on Percentage of patients with time in therapeutic range (TTR) ≥70% (p=0.017). The COVID-19 pandemic period was associated with a significant decrease in the percentage of patients achieving a time in therapeutic range ≥70% (33% vs 41.7%, p=0.017) and an increase in non-adherence to INR monitoring.
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