The Outcomes and Complications in Patients Taking Warfarin under the Development of Holistic Care and Multidisciplinary-Team Approach in Nakhonpathom Hospital
Keywords:
International normalized ratio (INR), time in therapeutic Range (TTR), warfarin, thromboembolism, bleedingAbstract
Objective: To evaluate the results of development of holistic care and multidisciplinary-approach in patients of the warfarin clinic, Nakhonpathom Hospital, and to compare the outcomes and complications before and after the development.
Methods: A retrospective study was done in patients taking warfarin in warfarin clinic, Nakhonpathom Hospital before and after the project of development of holistic care in warfarin clinic by multidisciplinary team, during 1 February 2016 - 31 December 2017 for before the project and 1 January 2018-1 October 2018 for after the project. Outcomes, i.e., time in treatment range (TTR) and rates of complications of before and after the project were evaluated and compared.
Results: Before the project development of holistic care in warfarin clinic by multidisciplinary team, 370 patients were included, 155 males (41.9%), 215 females (58.1%). Mean age was 64.3 years old (20-96). There were 203 atrial fibrillation (54.9%), 67 mitral stenosis with AF (18.1%), 30 post mechanical valve replacement (8.1%), 2 post bioprosthetic valve replacement (0.5%), 31 deep vein thrombosis (8.4%), 19 pulmonary embolism (5.1%), 4 stroke (1.1%), 1 arterial occlusion (0.3%), 1 intracardiac thrombus (0.3%) and 12 others (3.2%). After the project, 457 patients were included, 210 males (46.0%), 247 females (54.0%). Mean age was 64.0 years old (16-96). Of these, indications for warfarin were 247 atrial fibrillation (54.0%), 80 mitral stenosis with AF (17.5%), 42 post mechanical valve replacement (9.2%), 4 post bioprosthetic valve replacement (0.9%), 35 deep vein thrombosis (7.7%), 25 pulmonary embolism (5.5%), 7 stroke (1.5%), 1 arterial occlusion (0.2%), 2 intracardiac thrombus (0.4 %), and 14 others (3.1%). Mean TTR was increased from 53.6% to 56.4% when compared before to after the project (p value 0.035 at 95% CI -8.373 to -0.674). There were 239 patients who attended warfarin clinic before and maintained after the project, of these, mean TTR increased from 47.11% to 58.38% (p value 0.021 at 95% CI -14.935 to -7.612). Thrombosis and bleeding complications were reduced from 13.96 per 100 patient-years to 11.29 per 100 patient-years.
Conclusions: The development of holistic care in warfarin clinic by multidisciplinary team improved outcomes of treatment, it significantly increased mean TTR from 53.64% to 56.38% and reduced thrombosis and bleeding complications from 13.96 per 100 patient-years to 11.29 per 100 patient-years.
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ลิขสิทธิ์บทความเป็นของผู้เขียนบทความ แต่หากผลงานของท่านได้รับการพิจารณาตีพิมพ์ลงวารสารแพทย์เขต 4-5 จะคงไว้ซึ่งสิทธิ์ในการตีพิมพ์ครั้งแรกด้วยเหตุที่บทความจะปรากฎในวารสารที่เข้าถึงได้ จึงอนุญาตให้นำบทความในวารสารไปใช้ประโยชน์ได้ในเชิงวิชาการโดยจำเป็นต้องมีการอ้างอิงถึงชื่อวารสารอย่างถูกต้อง แต่ไม่อนุญาตให้นำไปใช้ในเชิงพาณิชย์
