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How to maximize warfarin therapy effectiveness and safety from the point of view of a clinical pharmacologist?

Sychev D. A., Gavrisiuk E. V., Al-Ahmad Faisal
State Budgetary Educational Institution “I. M. Sechenov First Moscow State Medical University” of the RF Ministry of Health Care, Trubetskaya 8, Bld. 2, Moscow 119991

Keywords: anticoagulation clinics, warfarin, bleeding, portable coagulometer, thrombosis, pharmacogenetic testing, patient schools

DOI: 10.18087/rhj.2012.5.1708

The review covers methods of increasing efficiency and safety of indirect anticoagulant warfarin. Efficiency of warfarin in patients with high risk of thromboembolic complications has been proved and is not questioned. However, according to foreign and Russian epidemiological researches, not all patients, to whom it warfarin is indicated, take it (according to the Russian data, not more than 51 % of patients who need it), and if it is prescribed, a therapeutic dose often is not adjusted, and efficiency control is often inadequate. It is connected with complex dose selection, coagulation control, risk of bleeding development. Methods of improvement of the Warfarin therapy quality are the following: training of patients in «warfarin» schools, supervision of patients in anticoagulation clinics / rooms, domestic control of the international normalized ratio (INR), pharmacogenetic testing for warfarin dose personification. Efficiency of such approaches has been confirmed in randomized controlled studies, and thus methods can be used in the clinical practice
  1. Суслина З. А., Варакин Ю. Я. Клинико-эпидемиологические исследования – перспективное направление изучения цереброваскулярной патологии (сообщение первое). Анналы клинической и экспериментальной неврологии. 2009;3 (3):4–11.
  2. Пономарева И. А., Воробьева Н. А. Эпидемиология тромбоэмболии легочной артерии по данным аутопсий. Анестезиология и реаниматология. 2007;3:9–13.
  3. Миллер О., Мурсалимова А., Гендлин Г., Сторожаков Г. Лечение аортального стеноза у пожилых пациентов. Врач. 2011;11:2–7.
  4. Сычев Д. А., Игнатьев И. В., Кукес В. Г. Оральные антикоагулянты: принципы индивидуализации применения. Лекарственные средства: Прикладная фармакология и персонализированная фармакотерапия. 2010;1 (1):12–18.
  5. Панченко Е. П. Антикоагулянтная терапия в кардиологии: вчера, сегодня завтра Кардиология. 2010;50 (7):8–14.
  6. Connolly S, Pogue J, Hart R et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet. 2006;367 (9526):1903–1912.
  7. Cannegieter SC, Vandermeer FJ, Briët E, Rosendaal FR. Warfarin and aspirin after heart-valve replacement. Nengljmed. 1994;330 (7):507–508.
  8. Oates-Whitehead RM, D'Angelo A, Mol B. Anticoagulant and aspirin prophylaxis for preventing thromboembolism after major gynaecologicalsurgery.Cochrane Database Syst Rev. 2003; (4):CD003679.
  9. ESPRIT. Oral anticoagulation in patients after cerebral ischemia of arterial origin and risk of intracranial hemorrhage. Stroke. 2003;34 (6):e45–46.
  10. Radwan MA, Bawazeer GA, Aloudah NM et al. Determination of free and total warfarin concentrations in plasma using UPLC MS / MS and its application to a patient samples. Biomedchromatogr. 2012 Jan;26 (1):6–11.
  11. Kimmel SE. Warfarin therapy: in need of improvement after all these years. Expertopinpharmacother. 2008 Apr;9 (5):677–686.
  12. Baczek VL, Chen WT, Kluger J, Coleman CI. Predictors of warfarin use in atrial fibrillation in the United States: a systematic review and meta-analysis. BMC Fam Pract. 2012;13:5.
  13. Winkelmayer WC, Bucsics AE, Schautzer A et al. Pharmaco­economics Advisory Council of the Austrian Sickness Funds. Eur J Epidemiol. Use of recommended medications after myocardial infarction in Austria. 2008;23 (2):153–162.
  14. Козлова Т. В., Таратута Т. В. Возможности оптимизации антикоагулянтной терапии варфарином. РМЖ. 2008;16 (11):46–53.
  15. Гаврисюк Е. В., Игнатьев И. В., Сычев Д. А. и др. Кукес. Анализ применения непрямого антикоагулянта варфарина у пациентов с постоянной формой фибрилляции предсердий в поликлинических условиях. Клиническая фармакология и терапия. 2012;1:42–45.
  16. Pernod G, Labarère J, Yver J et al. EDUC'AVK: reduction of oral anticoagulant-related adverse events after patient education: a prospective multicenter open randomized study. J Gen Intern Med. 2008;23 (9):1441–1446.
  17. Антонов И. М., Аристов Е. Г., Сычев Д. А. и др. Антикоуглянтные клиники: зарубежный опыт и перспективы для российского здравоохранения. Креативная кардиология. 2010;1:35–42.
  18. Winans AR, Rudd KM, Triller D. Assessing anticoagulation know­ledge in patients new to warfarin therapy. Ann Pharmacother. 2010;44 (7-8):1152–1157.
  19. Wilson SJ, Wells PS, Kovacs MJ Comparing the quality of oral anticoagulant management by anticoagulation clinics and by family physicians: a randomized controlled trial. CMAJ. 2003;169 (4):293–298.
  20. Wittkowsky AK, Nutescu EA, Blackburn J et al. Outcomes of oral anticoagulant therapy managed by telephone vs in-office visits in an anticoagulation clinic setting. Chest. 2006;130 (5):1385–1389.
  21. Nieuwlaat R, Connolly SJ, Mackay JA et al. Computerized clinical decision support systems for therapeutic drug monitoring and dosing: a decision-maker-researcher partnership systematic review. Implement Sci. 2011;6:90.
  22. Fitzmaurice DA, Murray ET, McCahon D Self management of oral anticoagulation: randomised trial. BMJ. 2005;331 (7524):1057.
  23. Menéndez-Jándula B, Souto JC, Oliver A et al. Comparing self-management of oral anticoagulant therapy with clinic management: a randomized trial. Ann Intern Med. 2005;142 (1):1–10.
  24. Heneghan C, Ward A, Perera R et al. Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data. Lancet. 2012;379 (9813):322–334.
  25. Matchar DB, Jacobson A, Dolor R et al. THINRS Executive Committee and Site Investigators. Effect of home testing of international normalized ratio on clinical events. N Engl J Med. 2010;363 (17):1608–1620.
  26. Lafata JE, Martin SA, Kaatz S, Ward RE. Anticoagulation clinics and patient self-testing for patients on chronic warfarin therapy: A cost-effectiveness analysis. J Thromb Thrombolysis. 2000;9 (Suppl 1):S13–19.
  27. Connock M, Stevens C, Fry-Smith A et al. Clinical effectiveness and cost-effectiveness of different models of managing long-term oral anticoagulation therapy: a systematic review and economic modelling. Health Technol Assess. 2007;11 (38):iii-iv, ix-66.
  28. Monagle P, Chan AK, Goldenberg NA et al; American College of Chest Physicians.Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.Chest. 2012;141 (2 Suppl): e737s-801S.
  29. Gage BF, Eby C, Johnson JA et al. Use of pharmacogenetic and clinical factors to predict the therapeutic dose of warfarin. Clin Pharmacol Ther. 2008;84 (3):326–331.
  30. Сычев Д. А., Антонов И. М., Игнатьев И. В. и др. Анти­коагулянтное действие и безопасность применения варфарина при его дозировании, основанном на результатах фармакогенетического тестирования: результаты первого российского проспективного исследования. Кардиология. – 2010;50 (5):42–46.
  31. Epstein RS, Moyer TP, Aubert RE et al. Warfarin genotyping reduces hospitalization rates results from the MM-WES (Medco-Mayo Warfarin Effectiveness study). J Am Coll Cardiol. 2010;55 (25):2804–2812.
  32. Герасимова К. В., Авксентьева М. В., Сычев Д. А. Оценка экономического преимущества фармакогенетического подхода к дозированию варфарина по сравнению с традиционным. Биомедицина. 2010;3:39–41.
Sychev D. A., Gavrisiuk E. V., Al-Ahmad Faisal. How to maximize warfarin therapy effectiveness and safety from the point of view of a clinical pharmacologist? Russian Heart Journal. 2012;11(5):264-271.

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