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
{"title":"华法林在抗凝药物治疗依从性临床中的抗凝控制","authors":"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","doi":"10.1002/jppr.1965","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Aim</h3>\n \n <p>To evaluate overall TTR and to analyse the occurrence of thromboembolic and bleeding complications in warfarin patients.</p>\n </section>\n \n <section>\n \n <h3> Method</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"55 4","pages":"327-335"},"PeriodicalIF":1.0000,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Anticoagulation control of warfarin in anticoagulation medication therapy adherence clinics\",\"authors\":\"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\",\"doi\":\"10.1002/jppr.1965\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Aim</h3>\\n \\n <p>To evaluate overall TTR and to analyse the occurrence of thromboembolic and bleeding complications in warfarin patients.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Method</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>In Malaysia, the anticoagulation control of warfarin under ACMTAC management is moderate, with about half of patients demonstrating good control levels. 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Anticoagulation control of warfarin in anticoagulation medication therapy adherence clinics
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.
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.
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