Evaluate the adequacy of Warfarin Treatment among Patients who were on long term Anticoagulation Therapy in Ahmed Gasim Cardiac Center, Khartoum- Suda

Abstract: Warfarin therapy for the prevention and treatment of thromboembolic diseases is safe and effective when it is maintained with a narrow therapeutic window measured by the international normalization ratio (I.N.R).Failure to provide adequate anticoagulation consistently predict thromboembolic events( eg stroke and pulmonary embolism), while excessively anticoagulated patients were at risk of bleeding. The management of therapy within this narrow window is complicated by numerous factors including drug interaction, comorbid acute, and chronic diseases, diet, and a variety of patient responses to warfarin therapy. The study was conducted in Ahmed Gasim cardiac center outpatient anticoagulation clinic. The study was carried out in the period from January to December 2012. Patients admitted or attending Ahmed Gasim cardiac center for followup of their long-term anticoagulation therapy. From all these results during the follow-up period. We found the percentage of those who were adequately controlled at the normal therapeutic I.N.R range was (54.7%) versus (45.3%) for uncontrolled patients. Of those who were controlled, we found(133) patients (60.7%) of them were fully educated about the interaction between diet and medications, while (31) patients (38.3%) were not receiving education about such interaction. On the other hand, those who were not controlled according to their therapeutic I.N.R (50) patients (61.7%) were not having educated and (86) patients (39.7%) were educated and have knowledge about dietary and drug interaction. P-value (0.01).The study of the adequacy of anticoagulation shows suboptimal control in (45.3%) of patients on patients attending INR clinics, however, the adequacy varies with age group with elderly patients poorly anticoagulated. Finally, the overall research conclude that the adequacy of anticoagulation was suboptimal with (54.6%) adequately controlled versus (45.3%) uncontrolled. In conclusion, the INR range of anticoagulation at the referral clinic mostly falls in the “under anticoagulated range”. Areas to be considered are patient attendance, staffing and at the same time increasing the efficiency of services. Improvement should be directed not only toward attaining better patient attendance at the clinic but also to educate patients on the importance of adequate control.