Assessment of Anticoagulation Control Association with Warfarin Knowledge and Demographic Features of Iranian Population

Background: Warfarin is the most commonly used oral anticoagulant for patients with atrial fibrillation, prosthetic heart valves, and deep vein thrombosis with a narrow therapeutic index. Due to the importance of patients’ adherence to treatment and also regular measurements of International normalized ratio (INR), this can have a significant impact on the quality of anticoagulation control. Objectives: The primary aim of this study was to assess the association between warfarin knowledge and time in therapeutic range (TTR) in patients on warfarin anticoagulation for at least 6 months who were referred to anticoagulation clinic in Rajaie Heart Center during 2016 - 2017. Methods: In this cross-sectional study, 620 patients who had been referred to the outpatient Rajaie Hospital anticoagulant clinic and had been taking warfarin for over six months were asked to fill two questionnaires named anticoagulation knowledge assessment (AKA) during a 12-week period. After obtaining the necessary permits, TTR (by Rosendal method) was calculated using the INR results of patients. Results: A total of 620 patients completed the questionnaire. The relation between warfarin knowledge and anticoagulation control was not significant. The mean age of the study population was 52.45 SD ± 14.01 years. This study showed a significant relationship between TTR, duration of warfarin usage (PV = 0.03) and the underlying cause of this usage (PV = 0.016). Conclusions: Prevention of chronic diseases is one of the most important priorities of the health care systems. Reduction in complications such as thrombosis and bleeding can be achieved by efforts to promote patient’s knowledge. By recognition of relation between warfarin knowledge and social and demographic indicators, patient’s education gap can be detected and also planned for dissolving. This study showed that although many of the patients visited in anticoagulation clinic have poor anticoagulation control, but a major part of them have good knowledge of warfarin usage.

Implementation and Evaluation of Virtual Anticoagulation Clinic Care to Provide Incessant Care During COVID-19 Times in an Indian Tertiary Care Teaching Hospital

Background: COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-II) has become a global pandemic disrupting public health services. Telemedicine has emerged as an important tool to deliver care during these situations. Patients receiving Vitamin K antagonists (VKA) require structured monitoring which has posed a challenge during this pandemic. We aimed to evaluate the impact of Virtual anticoagulation clinic (VAC), a Telehealth model on the quality of anticoagulation, adverse events, and patient satisfaction vis-a-vis standard Anticoagulation clinic (ACC) care.Materials and methods: A bidirectional cohort study was conducted in the Department of Cardiology, JSS Hospital, Mysore. Two hundred and twenty-eight patients in the VAC and 274 patients in the ACC fulfilling inclusion criteria were the subjects of the study. Telehealth tools like WhatsApp and telephone were used. Time in therapeutic range (TTR), Percentage of International normalized ratio in range (PINRR), and adverse events were analyzed and compared between the VAC group and the ACC group, between pre-COVID and COVID ACC groups, and between the VAC group and the same pre-COVID cohort. Patient satisfaction was assessed by a questionnaire at the end of 8 months. Descriptive statistics were used for the patient characteristics and inferential statistics for the comparisons between pre-VAC and VAC care.Results: The mean TTR was 75.4 ± 8.9% and 71.2 ± 13.4% in the VAC group and ACC group, respectively (p < 0.001). The mean PINRR was 66.7 ± 9.4% and 62.4 ± 10.9% in the VAC group and ACC group respectively, (p < 0.001). There was no significant difference in TTR between the VAC group and the same pre-COVID cohort. The TTR differential between the pre-COVID and COVID ACC groups was significant. In either group, no major adverse events were seen. The most common tools used for data exchange were WhatsApp (83%) and SMS (17%). Seventy-four percent of patients were extremely satisfied with the overall VAC care.Conclusions: Virtual anticoagulation clinic, a telehealth model can be used as an alternative option to deliver uninterrupted anticoagulation care during pandemic times.