Which is the best for the warfarin monitoring: Following up by fixed or variable physician?

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dc.authoridYilmaz, Mehmet Birhan/0000-0002-8169-8628
dc.contributor.authorAsarcikli, Lale Dinc
dc.contributor.authorKafes, Habibe
dc.contributor.authorSen, Taner
dc.contributor.authorIpek, Esra Gucuk
dc.contributor.authorBeton, Osman
dc.contributor.authorTemizhan, Ahmet
dc.contributor.authorYilmaz, Mehmet Birhan
dc.date.accessioned2024-10-26T18:00:30Z
dc.date.available2024-10-26T18:00:30Z
dc.date.issued2022
dc.departmentSivas Cumhuriyet Üniversitesi
dc.description.abstractOBJECTIVE: Warfarin therapy has some difficulties in terms of close monitoring and dosage. This study aims to evaluate the effect of same-fixed versus different-variable physician-based monitoring of warfarin therapy on treatment quality and clinical end-points. METHODS: A total of 625 consecutive patients requiring warfarin treatment were enrolled at seven centers. INR values of the patients measured at each visit and registered to hospital database were recorded. Time in therapeutic range (TTR) was calculated using linear interpolation method (Rosendaal's method). A TTR value of >= 65% was considered as effective warfarin treatment. If a patient was evaluated by the same-fixed physician at each INR visit, was categorized into the same-physician (SP) group. In contrast, if a patient was evaluated by different-variable physicians at each INR visit, was categorized into variable physician (VP) group. Enrolled patients were followed up for bleeding and embolic events. RESULTS: One hundred and fifty-six patients (24.9%) were followed by SP group, 469 (75.1%) patients were followed by VP group. Median TTR value of the VP group was lower than that of SP group (56.2% vs. 65.1%, respectively, p=0.009). During median 25.5 months (9-36) of follow-up, minor bleeding, major bleeding and cerebral embolic event rates were higher in VP group compared to SP group (p<0.001, p=0.023, p<0.001, respectively). In multivariate analysis, INR monitoring by VP group was found to be an independent predictor of increased risk of bleeding events (OR 2.55, 95% CI 1.64-3.96, p<0.001) and embolism (OR 3.42, 95% CI 1.66-7.04, p=0.001). CONCLUSION: INR monitoring by same physician was associated with better TTR and lower rates of adverse events during followup. Hence, it is worth encouraging an SP-based outpatient follow-up system at least for where warfarin therapy is the only choice.
dc.identifier.doi10.14744/nci.2021.06981
dc.identifier.endpage101
dc.identifier.issn2148-4902
dc.identifier.issue2
dc.identifier.pmid35582509
dc.identifier.scopus2-s2.0-85164619318
dc.identifier.scopusqualityN/A
dc.identifier.startpage93
dc.identifier.trdizinid526253
dc.identifier.urihttps://doi.org/10.14744/nci.2021.06981
dc.identifier.urihttps://search.trdizin.gov.tr/tr/yayin/detay/526253
dc.identifier.urihttps://hdl.handle.net/20.500.12418/27720
dc.identifier.volume9
dc.identifier.wosWOS:000791215800001
dc.identifier.wosqualityN/A
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakTR-Dizin
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherKare Publ
dc.relation.ispartofNorthern Clinics of Istanbul
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectAnticoagulation
dc.subjectembolism
dc.subjecthemorrhage
dc.subjectinternational normalized ratio
dc.subjectwarfarin
dc.titleWhich is the best for the warfarin monitoring: Following up by fixed or variable physician?
dc.typeArticle

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