Waqas Ahmed, Rida Asif, Usman Munir Khan, Muddassir Mehmood.
Compliance, frequency of target INR achievement and complications in patients on long term oral anticoagulant therapy.
Pak J Cardiol Jan ;18(1-2):7-11.

Objective: To assess compliance and achievement of target international normalized ratio (INR) in patients with a broad range of indications for long term oral anticoagulant therapy (OAT) with warfarin. Design: Case-review of 50 patients on long term OAT. Place and Duration of Study: Department of Cardiology, Shifa International Hospital, July 2004-Dec 2004. Methods: Medical records of 50 patients on long term OAT for at least six months and being followed in the cardiology out patient department (OPD) were reviewed. Data was collected and analyzed for indication for OAT, frequency of INR check, target INR achievement and subsequent complications. Descriptive statistics were used to detect frequencies. Results: Out of a total of 50 patients, 30 (60%) were male and 20 (40%) were female. Majority of the patients (61%) belonged to the cities of Islamabad and Rawalpindi. 40.9% of the patients were getting their INR checked every 1-2 months. 20.5% were getting it checked every 2-4 months and a third (38.6%) were having their INR checked more than 4 months apart. Commonest indications for OAT were atrial fibrillation alone (25%), prosthetic heart valve alone (29.5%) or both (20%). Average INR values were between 1-2 in 17 (38.6%), between 2-3 in 22 (50%) and more than 3 in 5 (11.4 %) patients. Major complications occurred in 2 (4.6%) patients only. Conclusions: Majority of the patients on long term OAT were getting their INR checked latter than recommended with a third of the patients with INR checks more than 4 months apart. More than a third of the patients did not achieve their target INR. However, despite these suboptimal results, major complications occurred very infrequently.

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