Association evaluation between pharmacotherapy complexity and oral anticoagulation quality in patients using warfarin
DOI:
https://doi.org/10.30968/rbfhss.2023.144.0992Abstract
Objective: To carry out the characterization and identification of the complexity of pharmacotherapy in patients treated in an anticoagulation clinic and associate it with the control of oral anticoagulation, through the TTR. Methods: Data collection was carried out through the application of questionnaires and prescription requests. The complexity analysis was based on the Medication Regimen Complexity Index (MRCI), developed by George et al. (2004) and validated in Brazilian Portuguese by Melchiors, Correr and Fernandez-Llimos (2007) with the title of Pharmacotherapy Complexity Index (ICFT). Prescriptions were classified into levels of complexity according to Pantuzza et al. (2018) who considered the total MRCI value ≤9.0 points low complexity; medium complexity as 9 <total MRCI ≤ 16.5 points; and high complexity as total MRCI > 16.5 points. The TTR was calculated according to the linear interpolation method described by Rosendaal et al. (1993) and expressed as a percentage. Results: The sample consisted of 203 patients aged >18 years and on chronic warfarin use (>60 days). Most patients, 66.5%, had inadequate TTR (<60%). Conclusion: The present study allows us to infer that there is no statistically relevant association between the complexity and quality of pharmacotherapy in this population, specifically.
Downloads
References
Wang M, Holbrook A, Lee M, et al. Barriers and facilitators to optimal oral anticoagulant management: a scoping review. J Thromb Thrombolysis. 2020; 50(3):697-714. doi: 10.1007/s11239-020-02056-0.
Weitz JI. Coagulação sanguínea e fármacos anticoagulantes, fibrinolíticos e antiplaquetários. In: Brunton LL, Chabner BA, Knollmann BC. As bases farmacológicas da terapêutica, 12 ed. Rio de Janeiro: Mcgraw Hill; 2012: 860-65.
Grzymala-Lubanski B, Svensson PJ, Renlund H, et al. Warfarin treatment quality and prognosis in patients with mechani- cal heart valve prosthesis. Heart. 2017;103(3):198-203. doi: 10.1136/heartjnl-2016-309585.
Andras A, Sala TA, Stewart M. Vitamin K antagonists versus low-molecular- weight heparin for the long term treatment of symptomatic venous thromboembolism. Cochrane Data- base Syst Rev. 2017;7(7):CD002001. doi: 10.1002/14651858. CD002001.
Ben RO, Brahim W, Ghali H, et al. Evaluation of the quality of long-term anticoagulation therapy with antivitamin-K in atrial fibrillation. Ann Cardiol Angeiol. 2019;68(2):80-86. doi: 10.1016/j.ancard.2018.08.024.
Teles JS, Fukuda EY, Feder D. Warfarin: pharmacological profile and drug interactions with antidepressants. Einstein. 2012;10(1):110-5. doi: 10.1590/s1679-45082012000100024.
Pantuzza LLN, das Graças CM, Reis EA, et al.. Factors associat- ed with high medication regimen complexity in primary care older adults in Brazil. Eur Geriatr Med. 2020;11(2):279- 287. doi: 10.1007/s41999-019-00275-0.
Wimmer BC, Cross AJ, Jokanovic N, et al.. Clinical Out- comes Associated with Medication Regimen Complexity in Older People: A Systematic Review. J Am Geriatr Soc. 2017;65(4):747-753. doi: 10.1111/jgs.14682.
Vazquez SR. Drug-drug interactions in an era of multiple an- ticoagulants: a focus on clinically relevant drug interactions. Blood. 2018;132(21):2230-2239. doi: 10.1182/blood-2018- 06-848747.
Ageno W, Gallus AS, Wittkowsky A, et al. Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Throm- bosis. American Col of Chest Physic Evidence-Based Clinic Pract Guidelines. 2012;141(2):e44S-e88S. doi: 10.1378/ chest.11-2292.
Guidoni CM. Estudo de utilização da varfarina em pacientes hospitalizados: análise de risco de interações medicamen- tosas e reações adversas [Tese de Doutorado em Ciências Farmacêuticas]. Universidade de Ciências Farmacêuticas de Ribeirão Preto, Ribeirão Preto, 2012.
Melchiors AC, Correr CJ, Fernández LF. Tradução e validação para o português do Medication Regimen Complexity Index. Arq Bras Cardiol. 2007;;89 (4):210-218. doi: 10.1590/S0066-782X2007001600001
Molteni M, Cimminiello C. Warfarin and atrial fibrillation: from ideal to real the warfarin affaire. Thromb J. 2014;12(1):5. doi: 10.1186/1477-9560-12-5.
Faircloth JM, Miner KM, Alsaied T, et al. Time in therapeutic range as a marker for thrombotic and bleeding outcomes in Fontan patients. J Thromb Thrombolysis. 2017;44(1):38-47. doi: 10.1007/s11239-017-1499-8.
George J, Phun YT, Bailey MJ, et al. Development and validation of the medication regimen complexity index. Ann Pharmacother. 2004;38(9):1369-76. doi: 10.1345/aph.1D479.
Pantuzza LL, Ceccato MDGB, Silveira MR, et al. Validation and standardization of the Brazilian version of the Medication Regimen Complexity Index for older adults in primary care. Geriatr Gerontol Int. 2018;18(6):853-859. doi: 10.1111/ ggi.13261.
Rosendaal FR, Cannegieter SC, van der Meer FJ, et al. A method to determine the optimal intensity of oral anticoagu- lant therapy. Thromb Haemost. 1993;69(3):236-9.
Dinç AL, Kafes H, Şen T, et al. Time in therapeutic range values of patients using warfarin and factors that influence time in therapeutic range. Turk Kardiyol Dern Ars. 2021;49(6):463- 473. doi: 10.5543/tkda.2021.21015.
Takamoto K, Sakamoto JI, Ito S, et al. Low Quality of Warfa- rin Therapy is Associated With Female Gender but Not With Polypharmacy in Patients With Atrial Fibrillation. Front Pharmacol. 2021;12:651799. doi: 10.3389/fphar.2021.651799.
Yimer NS, Abiye AA, Hussen SU, et al. Anticoagulation Control, Outcomes, and Associated Factors in Patients with Atrial Fibril- lation Receiving Warfarin at Tertiary Care Hospital in Ethiopia. Clin Appl Thromb Hemost. 2021;27:10760296211049786. doi: 10.1177/10760296211049786.
Silva MB, Sznejder H, Vasconcellos R, et al. Terapia de Anti- coagulação em Pacientes com Fibrilação Atrial não Valvar em Ambiente de Cuidado de Saúde Privado no Brasil: Um Estudo de Mundo Real. Arq. Bras. Cardiol. 2020;114(3):457-66. DOI: 10.36660/abc.20180076
Brasil. Presidência da República.Casa Civil. Subchefia para Assuntos Jurídicos. Decreto nº 8.842, de 4 de janeiro de 1994. Dispõe sobre a política nacional do idoso, cria o Conselho Nacional do Idoso e dá outras providências. Diário Oficial da União, Brasília, 1994.
Marcatto LR, Sacilotto L, Tavares LC, et al. Pharmaceutical Care Increases Time in Therapeutic Range of Patients With Poor Quality of Anticoagulation With Warfarin. Front Pharmacol. 2018;9:1052. doi: 10.3389/fphar.2018.01052.
Nam YH, Brensinger CM, Bilker WB, et al. Serious Hypoglyce- mia and Use of Warfarin in Combination With Sulfonylureas or Metformin. Clin Pharmacol Ther. 2019;105(1):210-218. doi: 10.1002/cpt.1146.
IBM Micromedex Drug Ref. Warfarin. IBM Corporation; 2021. Available in: www.micromedexsolutions.com. Acessed on 23 nov 2021.
Corrochano M, Jiménez B, Millón J, et al. Patient self-management of oral anticoagulation with vitamin K antagonists in everyday practice: clinical outcomes in a single centre cohort after long-term follow-up. BMC Cardiovasc Disord. 2020;20(1):166. doi: 10.1186/s12872-020-01448-7.
Alves CV, Rocha SS, Silva VN, et al. Are Clinical Outcomes Associated With Medication Regimen Complexity? A Sys- tematic Review and Meta-analysis. Ann Pharmacother. 2020;54(4):301-313. doi: 10.1177/1060028019886846.
Ramos LR, Tavares UL, Bertoldi AD, et al. Polifarmácia e polimorbidade em idosos no Brasil: um desafio em saúde pública. Rev Saúde Públ. 2016;50(2):9s. DOI: 10.1590/S1518-787.2016050006145.
Alves CV, Rocha SS, Silva VN, et al. Medication Regimen Com- plexity Measured by MRCI: A Systematic Review to Identify Health Outcomes. Ann Pharmacother. 2018;52(11):1117- 1134. doi: 10.1177/1060028018773691.
Colavecchia AC, Putney DR, Johnson ML, et al. Discharge medication complexity and 30-day heart failure readmissions. Res Social Adm Pharm. 2017;13(4):857-863. doi: 10.1016/j.sapharm.2016.10.002.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors hereby transfer, assign, or otherwise convey to RBFHSS: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print republish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to RHFHSS with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Serlf-archiving policy
This journal permits and encourages authors to post and archive the final pdf of the articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.
