Abstract

Title : Factors affecting INR control and bleeding of warfarin-treated patient, Warinchamrabhospital
By : TipwaneeThunyawan and Pithayathon Yomsrikhen
Degree : DOCTOR OF PHARMACY
Advisor : Peerawat Jinatongthai and Dr.Saksit Sripa
Keywords : warfarin, factors, control, INR, TTR
   
Warfarin is a narrow therapeutic index drug which is needed amonitor to maintain INR within the target range for optimal efficacy and safety.Due to its action could be affected by many factors, INR target is sometimes difficult to control. Objective:This analytical, cross-sectionalstudy was designed to determine factors affecting INR control and bleeding in warfarin-treated patients. Methods: Patients who visited the warfarin clinic during May 1st, 2015 to May 30th, 2016 were enrolled. Patient data were collected from medical records. Data were analyzed with descriptive statistic and logistic regression analysis. Results:Sixty patients were included into the study. Atrial fibrillation with valvular heart disease was the most indication of warfarin with 46.7%. The INR target for most patients (83.3%) was between 2.0 and 3.0. Thirty-seven percent of patients were achieved TTR over 60%. The results from multivariate logistic regression analysis showed that factor related to TTR under 60% was polypharmacy (OR=50.156, p=0.031). The results from descriptive analysis of the ratio of patient who had bleeding showed that the ratio of female patient compared with male patient were 38.7% and10.3% respectively (OR=5.474, p=0.011). The ratio of patient who had bleeding in patient with GFR overand under60 ml/min/1.73m2 were 46.7% and18.6% respectively (OR=3.828, p=0.033). Conclusion: Polypharmacy was the significant factor related to INR out of target, whereas female and GFR<60 ml/min/1.73m2could be a risk factor for bleeding in patient recieving warfarin. The results could be applied to improve in INR control of warfarin clinic at Warinchamrab hospital.
   
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