Laboratory of Genetics and Molecular Cardiology, Instituto Do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Escola Paulista de Medicina, Universidade Federal de São Paulo, EPM-Unifesp, Sao Paulo, Brazil.
J Thromb Thrombolysis. 2021 May;51(4):1043-1049. doi: 10.1007/s11239-020-02280-8. Epub 2020 Sep 24.
Poor adherence to warfarin treatment is a contributor to poor quality of treatment, which increases the risk of bleeding and thromboembolic events. This study aims to evaluate the impact of adherence to warfarin therapy on anticoagulation quality during 12 weeks of pharmaceutical care and after 1 year of follow-up for patients with atrial fibrillation and with poor TTR. The Arrhythmia Unit of tertiary hospital in Brazil. We included 262 patients with AF and poor quality of anticoagulation therapy with warfarin (TTR < 50%). Pharmacist-driven therapy management was performed for 12 weeks and patients were also evaluated 1 year after the end of the follow-up with a pharmacist. Adherence was classified into high adherence, medium adherence and low adherence. Impact of adherence to warfarin therapy after pharmaceutical care. Of the 262 patients, 160 were high adherence, 71 were medium adherence and 31 were low adherence. No statistically significant difference is found between adherence groups in demographic and clinical variables. The TTR basal means were not different among adherence groups (p = 0.386). However, the means of TTR 12 weeks and TTR 1 year after the end of protocol were statistically different among adherence groups (p < 0.001 and p = 0.002, respectively). When we compared TTR values at different times within the adherence group, we observed that there is a statistical difference between the three TTR means (basal versus 12 weeks versus 1 year after) within the adherence group (p < 0.001). Patients with poor anticoagulation control, who adhered to the treatment with warfarin during the pharmaceutical care had better anticoagulation quality compared to those who did not adhere to the therapy with warfarin.
华法林治疗的依从性差是治疗质量差的一个原因，这会增加出血和血栓栓塞事件的风险。本研究旨在评估在药物治疗的 12 周内和随访 1 年后，对房颤和 TTR 较差的患者的华法林治疗依从性对抗凝质量的影响。巴西三级医院心律失常科。我们纳入了 262 名房颤和华法林抗凝治疗质量差（TTR < 50%）的患者。进行了 12 周的药师驱动治疗管理，在随访结束后 1 年，患者还接受了药师的评估。依从性分为高依从性、中依从性和低依从性。药物治疗后的华法林治疗依从性的影响。在 262 名患者中，160 名患者为高依从性，71 名患者为中依从性，31 名患者为低依从性。在人口统计学和临床变量方面，依从性组之间没有统计学差异。依从性组之间的 TTR 基础平均值没有差异（p = 0.386）。然而，在药物治疗结束后 12 周和 1 年的 TTR 平均值在依从性组之间存在统计学差异（p < 0.001 和 p = 0.002）。当我们比较依从性组内不同时间的 TTR 值时，我们观察到在依从性组内，三个 TTR 平均值（基础值与 12 周与 1 年后）之间存在统计学差异（p < 0.001）。在药物治疗期间依从华法林治疗的抗凝控制差的患者，其抗凝质量优于不依从华法林治疗的患者。
