الفهرس 
COAGULATION
WARFARINOnly 14 pages are availabe for public view
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Abstract
Warfarin is the most frequently used oral anticoagulant worldwide because of it‘s availability and lower cost in comparison to other anticoagulant, the narrow therapeutic index and the highly variable toxic dose that characterizes warfarin constitute a challenge to its safe and effective use in clinical practice. Therefore, it is essential to apply best practice methods in initiation and management of patients on warfarin therapy. TTR is a recommended measure of outcomes of oral anticoagulation management and a good way of evaluating the quality of management of an anticoagulation clinic This study was conducted at Tanta University Hospitals aiming to study the INR values in patients on VKAs, find out the predictors of poor INR control in such cases. We included a total of 500 cases commenced on oral vitamin K antagonists. They were divided into two groups according to time to therapeutic range (TTR); subgroup I that included 288 patients with TTR < 65 and subgroup II that included 212 patients with TTR ≥ 65. Our results showed that: • Age was significantly younger in cases with TTR > 65. Old age was a significant risk factor for poor INR control on univariate analysis. • There was a significant difference between the two groups regarding gender (p = 0.029). Male gender was a significant risk factor for poor TTR on univariate analysis. Summ ary 90 • There was no significant difference between the two groups regarding residence areas (p = 0.134). • The level of education was significantly different between the study groups. Poor educational level was strongly associated with poor INR control. • Diabetes mellitus was a significant risk factor for poor INR control on univariate analysis. • Hypertension and chronic kidney disease were more prevalent in the poorly controlled group. • The presence of coronary artery disease was significantly more prevalent in the poorly controlled group. • Smoking was an independent risk factor for poor TTR (p = 0.001). Smokers represented 30.6 and 20.3 % of cases in both groups respectively. • There was a significant difference between the two groups regarding the duration of anticoagulant therapy (p = 0.019). Longer durations were observed in the poorly controlled group. • CHADS-VASC score showed significantly higher values in cases with low TTR (p < 0.001). • Using a cut-off value of 1.5, that score had sensitivity and specificity of 68.5 and 63.4% respectively to predict good TTR control, with an accuracy of 66.8%.