Anticoagulation control of warfarin in anticoagulation medication therapy adherence clinics

IF 1 Q4 PHARMACOLOGY & PHARMACY

Journal of Pharmacy Practice and Research Pub Date : 2025-02-05 DOI:10.1002/jppr.1965

Wardati Mazlan-Kepli BPharm, MPharm, PhD, Sahimi Mohamed BPharm, MPharm, PhD, Nik-Azlean Nik-Ismail BPharm, MPharm, Jivanraj R-Nagarajah BPharm, MPharm, Clinical Pharmacy Working Committee (Cardiology Subspecialty), Pharmaceutical Services Programme, Ministry of Health Malaysia

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Abstract

Background

Warfarin therapy remains essential in anticoagulation management and its quality is measured by the time in therapeutic range (TTR). In Malaysia, some healthcare centres provide the Anticoagulation Medication Therapy Adherence Clinic (ACMTAC) service for warfarin management, which is managed by pharmacists.

Aim

To evaluate overall TTR and to analyse the occurrence of thromboembolic and bleeding complications in warfarin patients.

Method

This cross-sectional, retrospective cohort study included patients who received warfarin treatment over a 3-year period (2019–2021). Data were collected from 49 healthcare centres in Malaysia with ACMTAC services. TTR was calculated using the Rosendaal method from international normalised ratio (INR) data acquired across these centres. TTR ≥ 65% was defined as good control of anticoagulation therapy. Ethical approval was granted by the Medical Research and Ethics Committee, Ministry of Health Malaysia (Reference no: NMRR- 21-779-59275) and the study conforms with the Declaration of Helsinki.

Results

The mean age (±standard deviation [SD]) of the 1464 included patients was 60.3 (±13.1) years, and 732 (50.0%) were male. Atrial fibrillation (65.7%) and valve replacement (23.1%) were the main indications for warfarin therapy. From 2019 to 2021, the annual mean TTR (±SD) were 63.1% (±24.5%), 64.0% (±25.0%), and 64.1% (±26.3%) respectively. For three consecutive years, more than 49% of patients achieved good control of anticoagulation therapy. Among the 49 centres, over 24 (49.0%) achieved a mean TTR of ≥65%, and the mean TTR varied significantly between centres (p < 0.001). The occurrence of bleeding and thromboembolic events was 227 (15.5%) and 15 (1.0%) respectively.

Conclusion

In Malaysia, the anticoagulation control of warfarin under ACMTAC management is moderate, with about half of patients demonstrating good control levels. Over a 3-year observation period, there was variation in TTR among the centres.

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华法林在抗凝药物治疗依从性临床中的抗凝控制

背景华法林治疗在抗凝管理中仍然是必不可少的，其质量是通过治疗范围内时间（TTR）来衡量的。在马来西亚，一些保健中心提供抗凝药物治疗依从性诊所（ACMTAC）服务，由药剂师管理华法林。目的评价华法林患者的总TTR，分析其血栓栓塞和出血并发症的发生情况。方法本横断面回顾性队列研究纳入了接受华法林治疗3年（2019-2021年）的患者。数据是从马来西亚49个提供ACMTAC服务的保健中心收集的。TTR使用Rosendaal方法从这些中心获得的国际标准化比率（INR）数据中计算。TTR≥65%定义为抗凝治疗控制良好。马来西亚卫生部医学研究和伦理委员会（参考编号：NMRR- 21-779-59275）批准了伦理许可，该研究符合《赫尔辛基宣言》。结果1464例患者平均年龄（±标准差[SD]）为60.3（±13.1）岁，男性732例（50.0%）。心房颤动（65.7%）和瓣膜置换术（23.1%）是华法林治疗的主要适应症。2019 - 2021年，年平均TTR（±SD）分别为63.1%（±24.5%）、64.0%（±25.0%）和64.1%（±26.3%）。连续3年，超过49%的患者抗凝治疗控制良好。在49个中心中，超过24个（49.0%）中心的平均TTR≥65%，中心之间的平均TTR差异显著（p < 0.001）。出血和血栓栓塞事件分别发生227例（15.5%）和15例（1.0%）。结论在马来西亚，ACMTAC管理下华法林的抗凝控制是中等的，约有一半的患者控制水平良好。在3年的观察期中，各中心的TTR存在差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Pharmacy Practice and Research Health Professions-Pharmacy

CiteScore

1.60

自引率

9.50%

发文量

期刊介绍： The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.