Patient-specific intervention enhances anticoagulation therapy
Interventions specifically tailored to patients with heart failure significantly improve anticoagulation therapy, suggests a recent study.
To examine the effect of a patient-specific tailored intervention on anticoagulation control, researchers randomly assigned patients with heart failure taking warfarin therapy (n=145) to either standard care or a one-time intervention assessing potential risk factors for lability of international normalized ratio (INR), in which they received specific instructions. They then assessed time in therapeutic range (TTR) using Rosendaal’s linear model 3 months before and after the intervention.
Anticoagulation control was significantly increased with the patient-specific tailored intervention. Prior to intervention, the median TTR levels were suboptimal in the interventional and control groups (53 vs 45 percent; p=0.14). After the intervention, the median TTR rose significantly in the interventional group compared with the control group (80 [interquartile range, 62 to 93 percent] vs 44 percent [29 to 61 percent]; p<0.0001).
The patient-tailored intervention led to a significant improvement in the interventional group before vs after intervention (53 vs 80 percent; p<0.0001) but not in the control group (45 vs 44 percent; p=0.95). The interventional group also had substantially higher percentage of patients with a TTR ≥60 percent, considered therapeutic, than the control group (79 vs 25 percent; p<0.0001).
After intervention, the interventional group, but not the control group, had a significantly reduced INR variability (standard deviation of each patient’s INR measurements) from 0.53 to 0.32 (p<0.0001).
“Many patients with heart failure need anticoagulants, including warfarin,” researchers said. “Good control is particularly challenging in heart failure patients, with <60 percent of INR measurements in the therapeutic range, thereby increasing the risk of complications.”