The Influence of Warfarin Adherence on Time in Therapeutic Range Among Patients with Mechanical Heart Valves

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dc.authorscopusid55317577700
dc.authorscopusid53663196500
dc.authorscopusid16315021800
dc.authorscopusid6505680586
dc.authorscopusid57202336559
dc.contributor.authorÖzkaramanlı Gür, Demet
dc.contributor.authorBaykız, Derya
dc.contributor.authorAkyüz, Aydın
dc.contributor.authorAlpsoy, Şeref
dc.contributor.authorFidan, Çiğdem
dc.date.accessioned2022-05-11T14:14:05Z
dc.date.available2022-05-11T14:14:05Z
dc.date.issued2018
dc.departmentFakülteler, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Kardiyoloji Ana Bilim Dalı
dc.departmentFakülteler, Tıp Fakültesi, Temel Tıp Bilimleri Bölümü, Tıbbi Biyokimya Ana Bilim Dalı
dc.description.abstractBACKGROUND: Despite considerations of its therapeutic range and multiple drug-food interactions, warfarin is the mainstay of oral anticoagulation in patients with mechanical heart valves (MHVs). The quality of anticoagulation demonstrates variations, with 'time in therapeutic range' (TTR) values usually lower than expected. It has been hypothesized that warfarin adherence is among the modifiable causes of suboptimal coagulation. The aim of the study was to demonstrate the ability of the 8-Item Morisky Medication Adherence Scale (MMAS-8©) to identify patients with non-adherence to warfarin, and to define the predictors of optimal coagulation when a TTR value ?65% is used as the surrogate. METHODS: In a cross-sectional survey of 112 patients, TTR6 months and TTR12 months were calculated using the Rosendaal method. A questionnaire was used to assess the patients' warfarin knowledge, bleeding complications, and adherence. Patients were categorized into low-adherence (LA), moderate adherence (MA) and high-adherence (HA) groups based on MMAS-8 values. The target INR was 2.5-3.5, and an effective TTR was defined as ?65%. RESULTS: TTR6 months, TTR12 months and warfarin knowledge were significantly lower in the LA group than in the MA and HA groups. In addition, the bleeding score of HA patients was significantly lower than that of LA and MA patients. The MMAS-8 was the single independent predictor of effective TTR for six and 12 months on multivariate regression analysis (B = 0.506, p <0.001 and B = 0.469, p <0.001, respectively). CONCLUSIONS: Warfarin adherence accounted for poor TTR values in patients with MHV, and MMAS-8 was used effectively to identify those expected to have a low TTR, to suffer more complications, and to require robust education.
dc.identifier.endpage64
dc.identifier.issn0966-8519
dc.identifier.issue1en_US
dc.identifier.pmid30560600
dc.identifier.scopus2-s2.0-85058747659
dc.identifier.scopusqualityQ4
dc.identifier.startpage55
dc.identifier.urihttps://hdl.handle.net/20.500.11776/5774
dc.identifier.volume27
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.institutionauthorÖzkaramanlı Gür, Demet
dc.institutionauthorBaykız, Derya
dc.institutionauthorAkyüz, Aydın
dc.institutionauthorAlpsoy, Şeref
dc.institutionauthorFidan, Çiğdem
dc.language.isoen
dc.publisherNLM (Medline)
dc.relation.ispartofThe Journal of heart valve disease
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.subjectanticoagulant agent
dc.subjectwarfarin
dc.subjectcross-sectional study
dc.subjecthealth care survey
dc.subjectheart valve prosthesis
dc.subjectheart valve replacement
dc.subjecthuman
dc.subjectinternational normalized ratio
dc.subjectmedication compliance
dc.subjecttime factor
dc.subjectvalvular heart disease
dc.subjectAnticoagulants
dc.subjectCross-Sectional Studies
dc.subjectHealth Care Surveys
dc.subjectHeart Valve Diseases
dc.subjectHeart Valve Prosthesis
dc.subjectHeart Valve Prosthesis Implantation
dc.subjectHumans
dc.subjectInternational Normalized Ratio
dc.subjectMedication Adherence
dc.subjectTime Factors
dc.subjectWarfarin
dc.titleThe Influence of Warfarin Adherence on Time in Therapeutic Range Among Patients with Mechanical Heart Valves
dc.typeArticle

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