Anticoagulation Management Practice And Associated Factors In Atrial Fibrillation Patients On Warfarin Therapy At Saint Paul Hospital Millennium Medical College

Anticoagulants are cornerstones in management of Atrial Fibrillation to prevent stroke.rnMonitoring of warfarin depends on time in therapeutic range, frequency of internationalrnnormalization range measurements, warfarin dose adjustments, warfarin drug interaction andrnbleeding adverse event. This study aimed to assess the anticoagulation management, and factorsrnaffecting anticoagulation management in atrial fibrillation patients taking warfarin. InstitutionalbasedrnrnRetrospective Cross-Sectional study was conducted from August to October 2019 at St.rnPaul Hospital Millennium Medical College. Data were collected retrospectively from a total ofrn300 patient medical records. Patients who have taken warfarin as an indication of primaryrnprevention of atrial fibrillation were included in the study. A systematic random samplingrntechnique was employed while recruiting the study participants. The data were entered tornStatistical Package for Social Science window version 25 for analysis. Descriptive summariesrnwere presented by using frequencies and percentages. Time in therapeutic range was calculatedrnusing the Rosendaal method, international normalization range frequency and drug interactionrnwith warfarin were assessed and warfarin dose adjustments were also checked. Univariate andrnmultivariate analysis were used to determine factors affecting time in therapeutic range andrnbleeding events. P-value ≤0.05 was considered as statistically significant. The mean age of thernpatient was 56.37 years and 65.3% of the study participants were females. Percent time inrntherapeutic range was found to be 42.03 ± 18.75. Only 12.67% patients had a time in therntherapeutic range above 65%. Out of the 3162 INR tests, only 1094(34.60%) tests were withinrnthe therapeutic range. Bleeding event was recorded on 62 (20.70%) of the patients. Poor time inrntherapeutic range was associated with only age between 65 and 74, number of comedication of 1rnand 2 and presence of congestive heart failure. Anticoagulation management was found to bernpoor in this study compared to other studies.

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