Christina E DeRemer1, Bliss McMichael2, Henry N Young3. 1. Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL, USA. 2. VA Tennessee Valley Healthcare System, Nashville, TN, USA. 3. UGA Clinical and Administrative Pharmacy, Robert C. Wilson Pharmacy, Athens, GA, USA.
Abstract
INTRODUCTION: Many factors influence international normalized ratio (INR); however, few studies have examined the impact of anemia in warfarin patients. The primary objective of this study was to explore the relationship between in-clinic anemia and the control of INR within an anticoagulation clinic. METHODS: A retrospective chart review was performed on a random sample of patients seen in an academic medical center pharmacy-managed anticoagulation clinic. Hemochron® Signature Elite machine was utilized to monitor point-of-care (POC) INR. In-clinic anemia was defined as hematocrit <32%. Statistical analyses were conducted using STATA MP a webbased platform ( https://www.stata.com/statamp/ ). RESULTS: Of the 300 patients analyzed, 45 (15%) patients had in-clinic anemia. Patients with in-clinic anemia were more likely to be younger (P < .05), female (P < .05), and have a diagnosis of sickle cell disease or anemia (P < .05). In the unadjusted logistic regression model, patients with in-clinic anemia were less likely to have an in-range INR ( OR: 0.52; 95% CI: 0.27-0.98). The adjusted regression model did not show significance. CONCLUSION: Study results suggest that in-clinic anemia may be more prevalent among younger, female patients prescribed warfarin, and patients diagnosed with in-clinic anemia may be a risk factor for out-of-range INR. Pharmacists practicing in anticoagulation clinics can incorporate this information into patient care practice in efforts to maintain optimal management.
INTRODUCTION: Many factors influence international normalized ratio (INR); however, few studies have examined the impact of anemia in warfarin patients. The primary objective of this study was to explore the relationship between in-clinic anemia and the control of INR within an anticoagulation clinic. METHODS: A retrospective chart review was performed on a random sample of patients seen in an academic medical center pharmacy-managed anticoagulation clinic. Hemochron® Signature Elite machine was utilized to monitor point-of-care (POC) INR. In-clinic anemia was defined as hematocrit <32%. Statistical analyses were conducted using STATA MP a webbased platform ( https://www.stata.com/statamp/ ). RESULTS: Of the 300 patients analyzed, 45 (15%) patients had in-clinic anemia. Patients with in-clinic anemia were more likely to be younger (P < .05), female (P < .05), and have a diagnosis of sickle cell disease or anemia (P < .05). In the unadjusted logistic regression model, patients with in-clinic anemia were less likely to have an in-range INR ( OR: 0.52; 95% CI: 0.27-0.98). The adjusted regression model did not show significance. CONCLUSION: Study results suggest that in-clinic anemia may be more prevalent among younger, female patients prescribed warfarin, and patients diagnosed with in-clinic anemia may be a risk factor for out-of-range INR. Pharmacists practicing in anticoagulation clinics can incorporate this information into patient care practice in efforts to maintain optimal management.
Entities:
Keywords:
INR; anemia; anticoagulation; point of care; warfarin
Authors: Syeda Rahman; Andrew Srisuwananukorn; Robert E Molokie; Michel Gowhari; Franklin Njoku; Faiz Ahmed Hussain; James Lee; Edith A Nutescu; Victor R Gordeuk; Santosh L Saraf; Jin Han Journal: Res Pract Thromb Haemost Date: 2021-05-27