Lookup NU author(s): Dr Salah Abohelaika,
Dr Hilary Wynne,
Dr Peter Avery,
Professor Farhad Kamali
This is the authors' accepted manuscript of an article that has been published in its final definitive form by Wiley-Blackwell Publishing, Inc., 2018.
For re-use rights please refer to the publisher's terms and conditions.
Objectives: Time within therapeutic INR range (TTR) predicts benefits/risk of warfarin therapy. Identification of individual- and centre-related factors that influence TTR, and addressing them to improve anticoagulation control, are important. This study examined the impact of individual and centre-related factors upon long-term anticoagulation control in atrial fibrillation patients in seven UK-based monitoring services. Methods: Data between 2000 and 2014 on 25,270 patients (equating to 203,220 patient years) [18,120 (71.7%) in general practice, 2,348 (9.3%) in hospital-based clinics and 4,802 (19.0%) in domiciliary service] were analysed.Results: TTR increased with increasing age, peaking around 77% at 70-75 years, and then declined, was lower in females than males, and in dependent home-monitored patients than those attending clinic (P<0.0001). TTR, number of dose changes and INR monitoring events, and the probability of TTR≤ 65%, differed across the centres (P<0.0001). Conclusions: Although all the participating centres ostensively followed a standard dosing algorithm, our results indicate that variations in practice do occur between different monitoring sites. We suggest feedback on TTR for individual monitoring sites gauged against the average values reported by others would empower the individual centres to improve quality outcomes of anticoagulation therapy by identifying and adjusting contributory factors within their management system.
Author(s): Abohelaika S, Wynne H, Avery P, Robinson B, Jones L, Tait C, Dickinson B, Salisbury J, Nightingale J, Green L, Kamali F
Publication type: Article
Publication status: Published
Journal: European Journal of Haematology
Print publication date: 01/10/2018
Online publication date: 27/06/2018
Acceptance date: 24/06/2018
Date deposited: 25/06/2018
ISSN (print): 0902-4441
ISSN (electronic): 1600-0609
Publisher: Wiley-Blackwell Publishing, Inc.
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