Lookup NU author(s): Salah Abohelaika,
Dr Hilary Wynne,
Dr Peter Avery,
Dr Patrick Kesteven,
Professor Farhad Kamali
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AimsStabilization of anticoagulation control is seminal to reducing the risk of adverse effects of vitamin K antagonists. Reliable information on how ageing influences this is lacking. We set out to assess the true age-related changes in anticoagulation control, how gender and patient setting influence this, and the possible implications of these for patient outcomes and management.MethodsIn atrial fibrillation (AF) patients of a unified anticoagulant service monitoring patients in general practice or hospital-based clinics and housebound patients at home, international normalized ratio (INR) and warfarin dose data between 2000 and 2013 were extracted via the DAWN dosing program. Anticoagulation control was assessed by calculating percentage time spent within target INR (TTR).ResultsA total of 2094 AF patients [938 (44.8%) in general practice (GP) and 531 (25.4%) in hospital (H)-based clinics and 625 (29.8%) through the domiciliary service (D)] were evaluated. The frequency of warfarin dose changes and INR monitoring events declined until about age 67, then increased as patients got older. The TTR according to age was significantly lower and the probability of having a TTR65% according to age was higher for D than for H and GP, and females had a greater probability of having a TTR 65% than age-matched males.ConclusionIdentification of factors underlying poorer anticoagulation control in older housebound patients and the introduction of effective modifications to improve the clinical effectiveness of anticoagulation in such patients is needed.
Author(s): Abohelaika S, Wynne H, Avery P, Robinson B, Kesteven P, Kamali F
Publication type: Article
Publication status: Published
Journal: British Journal of Clinical Pharmacology
Print publication date: 01/10/2016
Online publication date: 24/07/2016
Acceptance date: 12/06/2016
ISSN (print): 0306-5251
ISSN (electronic): 1365-2125
Publisher: Wiley-Blackwell Publishing Ltd.
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