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Thromb Res. 2017 Sep;157:120-125. doi: 10.1016/j.thromres.2017.07.007. Epub 2017 Jul 14.

Factors influencing warfarin control in Australia and Singapore.

Author information

1
Menzies Health Institute and Quality Use of Medicines Network, Queensland, Griffith University, Queensland, Australia; School of Pharmacy, Griffith University, Queensland, Australia.
2
Cardiology Department, National Heart Centre Singapore, Singapore.
3
Pharmacy Department, National Heart Centre Singapore, Singapore.
4
RCPA Quality Assurance Programs, New South Wales, Australia.
5
Menzies Health Institute and Quality Use of Medicines Network, Queensland, Griffith University, Queensland, Australia; Department of Emergency Medicine Gold Coast Health, Queensland, Australia.
6
Menzies Health Institute and Quality Use of Medicines Network, Queensland, Griffith University, Queensland, Australia; School of Pharmacy, Griffith University, Queensland, Australia. Electronic address: s.dukie@griffith.edu.au.

Abstract

INTRODUCTION:

Warfarin is widely used for patients with non-valvular atrial fibrillation (NVAF). Variations in warfarin control, as measured by time in therapeutic range (TTR), have been reported across different regions and ethnicities, particularly between Western and Asian countries. However, there is limited data on comparative factors influencing warfarin control in Caucasian and Asian patients. Therefore, the aim of this study was to determine warfarin control and potential factors influencing this in patients with NVAF in Australia and Singapore.

METHODS:

Retrospective data was collected for patients receiving warfarin for January to June 2014 in Australia and Singapore. TTR was calculated for individuals with mean patient TTR used for analysis. Possible influential factors on TTR were analysed including age, gender, concurrent co-morbidities, and concurrent medication.

RESULTS:

The mean TTR was significantly higher in Australia (82%) than Singapore (58%). At both sites, chronic kidney disease significantly lowered this TTR. Further factors influencing control were anaemia and age<60years in Australia, and vascular disease, CHA2DS2-VASc score of 6, and concurrent platelet inhibitor therapy in Singapore.

DISCUSSION:

Warfarin control was significantly higher in Australia compared to Singapore, however chronic kidney disease reduced control at both sites. The different levels of control in these two countries, together with patient factors further reducing control may impact on anticoagulant choice in these countries with better outcomes from warfarin in Australia compared to Singapore.

KEYWORDS:

Atrial fibrillation; International normalised ratio; Warfarin

PMID:
28738273
DOI:
10.1016/j.thromres.2017.07.007
[Indexed for MEDLINE]

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