The awareness, efficacy, safety, and time in therapeutic range of warfarin in the Turkish population: WARFARIN-TRAhmet Çelik1, Servet İzci2, Mehmet Ali Kobat3, Ahmet Hakan Ateş4, Abdülkadir Çakmak5, Yasin Çakıllı6, Mehmet Birhan Yılmaz7, Mehdi Zoghi8
1Department of Cardiology, Faculty of Medicine, Mersin University, Mersin- Turkey
2Department of Cardiology, Koşuyolu Education and Research Hospital, İstanbul- Turkey
3Department of Cardiology, Faculty of Medicine, Fırat University, Elazığ- Turkey
4Department of Cardiology, Samsun Education and Research Hospital, Samsun- Turkey
5Department of Cardiology, Faculty of Medicine, Amasya University, Amasya- Turkey
6Department of Cardiology, Siyami Ersek Education and Research Hospital, İstanbul- Turkey
7Department of Cardiology, Faculty of Medicine, Cumhuriyet University, Sivas- Turkey
8Department of Cardiology, Faculty of Medicine, Ege University, İzmir- Turkey
Objective: The awareness, time in therapeutic range (TTR), and safety of warfarin therapy were investigated in the adult Turkish population.Keywords: time in therapeutic range, warfarin, Turkish population
Methods: This multicenter prospective study includes 4987 patients using warfarin and involved regular international normalized ratio (INR) monitoring between January 1, 2014 and December 31, 2014. TTR was calculated according to F.R. Roosendaals algorithm. Awareness was evaluated based on the patients knowledge of warfarins affect and fooddrug interactions.
Results: The mean TTR of patients was 49.52±22.93%. The patients with hypertension (55.3%), coronary artery disease (23.2%), congestive heart failure (24.5%), or smoking habit (20.8%) had significantly lower TTR levels than the others. Of the total number of patients, 42.6% had a mechanical valve, 38.4% had non-valvular atrial fibrillation (AF), and 19% had other indications for warfarin. Patients with other indications had lower TTR levels than those with mechanical valve and non-valvular AF (p=0.018). Warfarin awareness decreased in higher age groups. The knowledge of warfarins fooddrug interactions was 55%. People with higher warfarin awareness had higher TTR levels. Patients with ≤8 INR monitoring/year had lower TTR levels (46.4±25.3 vs. 51.1±21.3, respectively, p<0.001) and lower awareness (44.6% vs. 60.6%, p<0.001) than patients with ≥8 INR monitoring/year. In this study, 20.1% of the patients had a bleeding event (major bleeding 15.8%, minor bleeding 84.2%) within a year.
Conclusion: Both the mean TTR ratios and awareness of the Turkish population on warfarin therapy were found to be low. It was thought that low TTR levels of the Turkish population may be caused by the low awareness of warfarin, warfarins fooddrug interactions, and high rates of concomitant diseases. (Anatol J Cardiol 2016; 16: 000-00)
Ahmet Çelik, Servet İzci, Mehmet Ali Kobat, Ahmet Hakan Ateş, Abdülkadir Çakmak, Yasin Çakıllı, Mehmet Birhan Yılmaz, Mehdi Zoghi. The awareness, efficacy, safety, and time in therapeutic range of warfarin in the Turkish population: WARFARIN-TR. Anatol J Cardiol. 2016; 16(8): 595-600
Corresponding Author: Ahmet Çelik, Türkiye