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IntroductionTime in therapeutic range (TTR) assesses the safety and effectiveness of warfarin therapy using the international normalised ratio. This study investigated the TTR in Hong Kong patients using both European and Japanese therapeutic ranges and patients' economic and clinical outcomes. Predictors of poor warfarin control and patient knowledge concerning warfarin therapy were assessed.MethodsA 5-month observational study with retrospective and prospective components was conducted in the Prince of Wales Hospital. The study examined electronic patient records of patients who received warfarin for at least 1 year during the period from January 2010 to August 2015. Patient knowledge was assessed via phone interview using the Oral Anticoagulation Knowledge (OAK) test.ResultsIn total, 259 patients were included; 174 completed the OAK test. The calculated mean TTR was 40.2±17.1% (European therapeutic range), compared with 49.1±16.1% (Japanese therapeutic range) [P<0.001]. Mean TTR was higher in patients with atrial fibrillation than in patients with prosthetic heart valve (P<0.001). The abilities of TTR to predict clinical and economic outcomes were comparable between European and Japanese therapeutic ranges. Patients with ideal TTR had fewer clinical complications and lower healthcare costs. Patients with younger age exhibited worse TTR, as did those with concurrent use of furosemide, famotidine, or simvastatin. Mean OAK test score was 54.1%. Only 24 (13.8%) patients achieved a satisfactory overall score of ≥75% in the test.ConclusionWarfarin use in Hong Kong patients was poorly controlled, regardless of indication. Patient knowledge concerning warfarin use was suboptimal; thus, additional patient education is warranted regarding warfarin.

Original publication

DOI

10.12809/hkmj208416

Type

Journal article

Journal

Hong kong medical journal = xianggang yi xue za zhi

Publication Date

08/2020

Volume

26

Pages

294 - 303

Addresses

School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.

Keywords

Humans, Atrial Fibrillation, Warfarin, Anticoagulants, International Normalized Ratio, Treatment Outcome, Retrospective Studies, Prospective Studies, Health Knowledge, Attitudes, Practice, Time Factors, Aged, Middle Aged, Health Care Costs, Patient Acceptance of Health Care, Hong Kong, Female, Male, Acute Coronary Syndrome