Key result
Among hospitalized patients receiving vitamin K antagonists, 53% had an INR outside the therapeutic range at admission, with correct INR predicted by higher education and mechanical prosthesis.
Why the study?
What factors predict a correct therapeutic INR range in patients receiving vitamin K antagonists?
Cross-Sectional (n=68)
No
What factors predict a correct therapeutic INR range in patients receiving vitamin K antagonists?
Over half of hospitalized patients on VKAs have out-of-range INRs at admission, highlighting the need for targeted patient education, particularly for those with lower education levels or non-mechanical valve indications.
Frequent out-of-range INRs at VKA admission support education assessment; leaves open whether targeting lower education improves control.
BACKGROUND: Patient adherence is an essential factor in obtaining efficient oral anticoagulation using vitamin K antagonists (VKAs), a situation with a narrow therapeutic window. Therefore, patient education and awareness are crucial for good management. Auditing the current situation would help to identify the magnitude of the problem and to build tailored education programs for these patients. METHODS: This study included 68 hospitalized chronically anticoagulated patients (mean age 62.6±13.1 years; males, 46%) who responded to a 26-item questionnaire to assess their knowledge on VKA therapy management. Laboratory and clinical data were used to determine the international normalized ratio (INR) at admission, as well as to calculate CHA2DS2-VASC and HAS-BLED scores for patients with atrial fibrillation. RESULTS: The majority of patients (62%) were receiving VKA for atrial fibrillation, the others for a mechanical prosthesis and previous thromboembolic disease or stroke. In the atrial fibrillation group, the mean CHA2DS2-VASC score was 3.1±1.5, while the average HAS-BLED score was 1.8±1.2. More than half of the patients (53%) had an INR outside of the therapeutic range at admission, with the majority (43%) having a low INR. A correct INR value was predicted by education level (higher education) and the diagnostic indication (patients with mechanical prosthesis being best managed). Patients presenting with a therapeutic INR had a trend toward longer treatment duration than those outside the therapeutic range (62±72 months versus 36±35 months, respectively, P=0.06). There was no correlation between INR at admission and the patient's living conditions, INR monitoring frequency, and bleeding history. CONCLUSION: In a tertiary cardiology center, more than half of patients receiving VKAs are admitted with an INR falling outside the therapeutic range, irrespective of the bleeding or embolic risk. Patients with a mechanical prosthesis and complex antithrombotic regimens appear to be the most careful with INR monitoring, especially if they have a higher level of education. Identifying patient groups with the lowest time interval spent in the therapeutic range could help attending physicians educate patients focusing on specific awareness issues.
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Jurcuţ et al. (2015) conducted a cross-sectional in Chronic anticoagulation with vitamin K antagonists (n=68). Vitamin K antagonist therapy was evaluated on INR outside of the therapeutic range at admission. Among hospitalized patients receiving vitamin K antagonists, 53% had an INR outside the therapeutic range at admission, with correct INR predicted by higher education and mechanical prosthesis.
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