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April 26, 2021Frontiers in Pharmacology8 citationsOpen Access

Low Quality of Warfarin Therapy is Associated With Female Gender but Not With Polypharmacy in Patients With Atrial Fibrillation

KTKojiro TakamotoJSJun-ichi SakamotoSISatoyasu Ito

Key Result

Polypharmacy did not deteriorate the quality of warfarin therapy in patients with atrial fibrillation, whereas female gender was an independent predictor of lower quality of warfarin therapy.

Study Design

Type

Observational (n=157)

Multicenter

No

Structured PICO

Does polypharmacy deteriorate the quality of warfarin therapy in patients with atrial fibrillation?

P
Population
157 consecutive outpatients with non-valvular atrial fibrillation in a single tertiary referral hospital in Japan, mean age 72.1, 77.1% male. Key inclusion: prescribed warfarin continuously and received PT-INR examination at least three times during a 1-year period.
I
Intervention
Warfarin therapy in the setting of polypharmacy (defined as being prescribed 5 or more medications regularly).
C
Comparator
Warfarin therapy without polypharmacy (prescribed 4 or fewer medications regularly).
O
Outcome
Quality of warfarin therapy evaluated by time in the therapeutic INR range (TTR), percentage of PT-INR determinations in range (PINRR), and coefficient variation (CV) of PT-INR.surrogate

In patients with atrial fibrillation, polypharmacy does not deteriorate the quality of warfarin therapy, but female gender is an independent predictor of lower anticoagulation quality.

Main Result

Absolute Event Rate: 78% vs 78%

p-value: p=0.670

Limitations

  • Small sample size
  • Small proportion of patients without polypharmacy
  • Small proportion of female patients
  • Lack of data on dietary intake of Vitamin K containing foods
  • Small sample size, specifically small proportions of patients without polypharmacy and female patients

Abstract

Background: We examined the impact of polypharmacy on the quality of the anticoagulation therapy in patients with atrial fibrillation. We also examined the factors that affect the stability of warfarin therapy. Methods and Results: This retrospective study was conducted using data from 157 consecutive outpatients with atrial fibrillation in a single tertiary referral hospital. Patients who were prescribed warfarin continuously and for whom PT-INR was examined at least three times in a year were included in this study. We examined the quality of warfarin therapy using time in the therapeutic INR range (TTR), percentage of PT-INR determinations in range (PINRR), and the coefficient variation (CV) of PT-INR. We found that the number of prescribed medicines was significantly associated with high BMI and low eGFR, but not with TTR, PINRR, and the coefficient variation of PT-INR in patients with atrial fibrillation. We also found that female gender was independently associated with low PINRR in this study population. Conclusion: Polypharmacy did not deteriorate the quality of warfarin therapy in patients with atrial fibrillation treated in the tertiary referral hospital. Female gender was an independent predictor of the low quality of warfarin therapy.

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Cite This Study

Takamoto et al. (2021) conducted an observational in Atrial Fibrillation (n=157). Polypharmacy (≥5 medications) vs. Non-polypharmacy (≤4 medications) was evaluated on Percentage of PT-INR determinations in range (PINRR) (p=0.670). Polypharmacy did not deteriorate the quality of warfarin therapy in patients with atrial fibrillation, whereas female gender was an independent predictor of lower quality of warfarin therapy.

synapsesocial.com/papers/6a1658e24d579d8bfbd96c70https://doi.org/10.3389/fphar.2021.651799
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