Fenta Teferi Gedif, Assefa Tamrat, Alemayehu Bekele
School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
BMC Health Serv Res. 2017 Jun 6;17(1):389. doi: 10.1186/s12913-017-2330-0.
Warfarin is the most widely used anticoagulant in the world. The difficulty of managing warfarin contributes to great potential for patient harm, both from excessive anticoagulation and insufficient anticoagulation. This study assessed the International Normalized Ratio (INR) control outcome measures and warfarin dose adjustment practices at cardiology and hematology outpatient clinics at a teaching hospital in Addis Ababa, Ethiopia.
The study was based on a cross - sectional study design involving 360 retrospective patients' chart review among outpatients who received warfarin for its various indications.
The mean frequency of INR monitoring per patient was 62.9 days (17.2-143.7 days). Patients spent 52.2%, 29.0% and 18.8% of the time in sub-therapeutic, therapeutic and supra-therapeutic ranges, respectively. The daily warfarin dose was increased 50.9% and 36.9% and decreased in 52.8% and 60.9% of the time for occurrences of sub-therapeutic and supra-therapeutic INRs to achieve target ranges of 2.0-3.0 and 2.5-3.5, respectively.
The quality of anticoagulation management with warfarin among outpatients in Tikur Anbessa Specialized Hospital was sub-optimal. This was reflected by low Time in Therapeutic Range (TTR), longer than recommended INR monitoring frequency, and minimal actions taken to adjust warfarin dose after occurrences of non-therapeutic INRs.
华法林是全球使用最广泛的抗凝剂。华法林管理的难度导致患者因抗凝过度和抗凝不足而面临极大的潜在伤害风险。本研究评估了埃塞俄比亚亚的斯亚贝巴一家教学医院的心脏病学和血液学门诊诊所的国际标准化比值（INR）控制结果指标及华法林剂量调整实践。
该研究基于横断面研究设计，对360例因各种适应证接受华法林治疗的门诊患者的病历进行回顾性分析。
每位患者INR监测的平均频率为62.9天（17.2 - 143.7天）。患者分别有52.2%、29.0%和18.8%的时间处于治疗不足、治疗中和治疗过度范围内。对于治疗不足和治疗过度的INR情况，为使目标范围分别达到2.0 - 3.0和2.5 - 3.5，华法林每日剂量增加的时间分别为50.9%和36.9%，减少的时间分别为52.8%和60.9%。
提古安贝萨专科医院门诊患者使用华法林的抗凝管理质量欠佳。这体现在治疗范围内时间（TTR）较低、INR监测频率长于推荐值，以及在出现非治疗性INR后调整华法林剂量的措施极少。
