Badawoud Amal M, Alanizi Abdalrhman, Alnakhli Adel O, Alzahrani Wafa, AlThiban Hadil S, AlKhurayji Reema W, Alnakhli Anwar Mansour, Alamoudi Jawaher Abdullah, Al Yami Majed S
Princess Nourah bint Abdulrahman University, College of Pharmacy, Department of Pharmacy Practice, P.O. Box 84428, Riyadh 11671, Saudi Arabia.
King Abdullah bin Abdulaziz University Hospital (KAAUH), Pharmaceutical Care Department, Riyadh, Saudi Arabia.
Saudi Pharm J. 2024 Jan;32(1):101906. doi: 10.1016/j.jsps.2023.101906. Epub 2023 Dec 9.
Warfarin is favored over newer direct oral anticoagulants (DOACs) for many older adults. However, its use necessitates rigorous monitoring due to the fine line between toxic and therapeutic doses. Few studies have evaluated the anticoagulation quality of warfarin among elderly patients in Saudi Arabia. This study aimed to assess and identify factors affecting the anticoagulation quality of warfarin using the time in the therapeutic range (TTR) among older adults attending two hospitals in Saudi Arabia. Additionally, we aimed to evaluate differences in the anticoagulation quality of warfarin when managed by pharmacists or physicians. This cross-sectional study was conducted at King Abdullah bin Abdulaziz University Hospital (KAAUH) and King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia. After calculating the TTR of each patient, the anticoagulation control level was determined using these values: a) good control: >70 %; b) intermediate control: 50-70 %; c) poor control: <50 %. A total of 132 patients prescribed warfarin therapy for different indications were included. Most patients (45.5 %) had poor control with TTRs < 50 %, while 18.2 % had intermediate control, and 36.4 % had good control. Our exploratory findings suggest that having three or more comorbidities was a significant factor associated with a poor TTR [odds ratio (OR) = 3.36; (95 % confidence interval 1.28-8.81); = 0.014]. Thus, the anticoagulation quality of warfarin among older adult patients was poor in two Saudi Arabian tertiary hospitals, and the number of comorbidities was a potentially poor TTR predictor.
对于许多老年人来说，华法林比新型直接口服抗凝剂（DOACs）更受青睐。然而，由于其毒性剂量和治疗剂量之间的界限很细微，使用时需要严格监测。很少有研究评估沙特阿拉伯老年患者使用华法林的抗凝质量。本研究旨在通过沙特阿拉伯两家医院老年患者的治疗范围内时间（TTR）来评估和确定影响华法林抗凝质量的因素。此外，我们旨在评估由药剂师或医生管理时华法林抗凝质量的差异。这项横断面研究在沙特阿拉伯利雅得的阿卜杜拉·本·阿卜杜勒阿齐兹国王大学医院（KAAUH）和法赫德国王医疗城（KFMC）进行。在计算每位患者的TTR后，使用以下值确定抗凝控制水平：a）良好控制：>70%；b）中等控制：50 - 70%；c）差控制：<50%。共有132名因不同适应症接受华法林治疗的患者被纳入。大多数患者（45.5%）的TTR<50%，控制较差，而18.2%为中等控制，36.4%为良好控制。我们探索性的研究结果表明，患有三种或更多合并症是与TTR较差相关的一个重要因素[比值比（OR）= 3.36；（95%置信区间1.28 - 8.81）；P = 0.014]。因此，在沙特阿拉伯的两家三级医院中，老年患者使用华法林的抗凝质量较差，合并症的数量是TTR潜在的不良预测指标。
