Jahde Dennis1, William Majoni2, Jeffrey Tinsley3, Nadarajah Kangaharan4. 1. Department of Cardiology, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia. Electronic address: jahde.dennis@nt.gov.au. 2. Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia; Flinders University and Northern Territory Clinical School, Royal Darwin Hospital Campus, Darwin, NT, Australia. 3. Department of Cardiology, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia. 4. Department of Cardiology, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia; Flinders University and Northern Territory Clinical School, Royal Darwin Hospital Campus, Darwin, NT, Australia; Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia; Menzies School of Health Research, Jon Mathews Building, Royal Darwin Hospital Campus, Darwin, NT, Australia.
Abstract
BACKGROUND: Warfarin remains a widely used anticoagulant but application in the remote context is not well documented. This study aimed to assess in more detail whether warfarin is being utilised effectively in Australia's most isolated and remote areas. METHODS: Retrospective cohort analysis of 2013 captured international normalised ratio (INR) results from people engaged in long term warfarin usage within a number of remote Northern Australian communities. Assessment of monitoring, effectiveness of dosing and complication rates was undertaken. RESULTS: A cohort of 167 patients was established. On average, warfarin was utilised within therapeutic range 52% of the time. Monitoring frequency averaged 16 days. Major bleeding and thrombo-embolism occurred at rates of 5.8 and 4.1 per 100 patient years respectively. CONCLUSIONS: Therapeutic utilisation of warfarin in this setting is close to accepted rates but has room for improvement. Monitoring was acceptable and complication rates were not disproportionately high. This study indicates that warfarin is being used with reasonable safety and efficacy in remote regions, but further research is needed.
BACKGROUND:Warfarin remains a widely used anticoagulant but application in the remote context is not well documented. This study aimed to assess in more detail whether warfarin is being utilised effectively in Australia's most isolated and remote areas. METHODS: Retrospective cohort analysis of 2013 captured international normalised ratio (INR) results from people engaged in long term warfarin usage within a number of remote Northern Australian communities. Assessment of monitoring, effectiveness of dosing and complication rates was undertaken. RESULTS: A cohort of 167 patients was established. On average, warfarin was utilised within therapeutic range 52% of the time. Monitoring frequency averaged 16 days. Major bleeding and thrombo-embolism occurred at rates of 5.8 and 4.1 per 100 patient years respectively. CONCLUSIONS: Therapeutic utilisation of warfarin in this setting is close to accepted rates but has room for improvement. Monitoring was acceptable and complication rates were not disproportionately high. This study indicates that warfarin is being used with reasonable safety and efficacy in remote regions, but further research is needed.
Authors: Piotr Sobolewski; Waldemar Brola; Jacek Wilczyński; Wiktor Szczuchniak; Tomasz Wójcik; Aleksandra Wach-Klink; Marek Kos; Grzegorz Kozera Journal: Clin Interv Aging Date: 2020-09-24 Impact factor: 4.458