Reasons for low adherence to anticoagulant therapy with warfarin

DOI: https://doi.org/10.29296/25877305-2023-09-04
Issue: 
9
Year: 
2023

A. Sabirzyanova(1), Candidate of Medical Sciences; Professor A. Galyavich(1), MD; R. Khairullin(2), MD; L. Baleeva(1), Candidate of Medical Sciences; Associate Professor Z. Galeeva(1), Candidate of Medical Sciences; A. Galimzyanov(2), Candidate of Medical Sciences; D. Safin(2); M. Sluiter(3); S. Akimova(3)
1-Кazan State Medical University, Ministry of Health of Russia
2-Interregional Clinical and Diagnostic Center, Kazan
3-ООО “PortavitaHealth”, Kazan

Objective. To assess patients' adherence to therapy with warfarin, to identify main reasons for its discontinuation or lack of timely the international normalized ratio (INR) monitoring. Material and methods. The database of anticoagulant rooms controlling the intake of warfarin was analyzed. Adherence to warfarin therapy was assessed by interviewing patients. The data were statistically processed using the computational program Statistica v10.0. Results. Only 20.6% of the patients who were prescribed warfarin to prevent thromboembolic events in the presence of non-valvular atrial fibrillation (AF) continue to take it. Of them, 69.2% regularly monitored INR. In the subgroup using warfarin after artificial heart valves had been installed; 32.4% of the patients continued its outpatient use; in 24.5% of them had an INR within the therapeutic range of ≥70%. There were main reasons for the termination of INR control: the fear of visiting polyclinics and anticoagulant rooms due to the epidemiological situation in 2021-2022; the presence of queues in the polyclinics; residence change and the inability to control INR within walking distance; movement difficulties experienced by patients with limited mobility; most patients stopped INR control because they were not properly informed about its necessity and the possible consequences of uncontrolled intake of warfarin. Conclusion. Among the patients with non-valvular AF and prosthetic heart valves who were prescribed warfarin, 74.9% stopped taking it after discharging from the hospital. The patients receiving warfarin in an outpatient setting controlled INR in ≤83.3% of cases.
Keywords: 
warfarin
anticoagulant therapy adherence
atrial fibrillation
artificial heart valves
international normalized ratio.

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