Utilization for Warfarin Therapy Among Jordanian People and Its Relation with International Normalized Ratio Control- Cross-Sectional Study at Queen Alia Heart Institution

: Oral anticoagulant therapy (OAT) has demonstrated a reduction in morbidity and mortality of thromboembolic complications. Universally, the management of anticoagulant therapy is a great challenge for laboratory and clinical services. Warfarin is associated with a number of adverse drug reactions and complications which could be decreased by better anticoagulation control. Treatment with it requires proper and regular monitoring to prevent thromboembolic complications as well as to prevent over anticoagulation state. International normalized ratio (INR) is an easily distinguished clinical parameter associated with a moderate degree of increased risk of thromboembolism in warfarin patients. Many factors are responsible for INR fluctuation in warfarin treatment, these include aging, dosage error, laboratory error, poor compliance, concomitant use with other drugs, concomitant illness, kidney and liver dysfunction, and dietary interaction. In spite of the guidelines that outline the benefits of using warfarin clearly, it remains to be underutilized. This has resulted in increased mortality and morbidity among affected patients. Anticoagulant underutilization risk factors are: old age, female sex, vascular disease presence, limited options of anticoagulant, and having insurance medical aid. The aim of the study was to provide the first national utilization of warfarin among their users as well as to evaluate the therapeutic INR monitoring for it in Jordan. Methods: A prospective observational cross-sectional study was conducted on 133 patients during a period of six weeks: (from 24th of December 2018 to 29th of January 2019) at the Anticoagulation Clinic at Queen Alia Heart Institute, who were on warfarin therapy. Results: Among 133 patients who completed the study, the majority of patients (48.12%) had good control with safe warfarin management with a total frequency of sixty-four patients, while thirty-five patients (26.32%) had a safe warfarin management approach only, and almost an equal number of patients (25.56%) had un-safe warfarin management with almost sixty percent; an average TTR score. This study found that ninety-six percent of patients received warfarin for three major indications which are: Atrial fibrillations, aortic valve replacement, and mitral valve replacement. Interestingly, the study found that eighty-one percent of warfarin users had at least one DDI. Also, this study, found that approximately fifty-six percent of patients were receiving furosemide medication, while, forty-eight percent of them were receiving atorvastatin medication, and almost thirtyseven percent of them were receiving bisoprolol medication. Conclusion: This observational study called for strategies to enhance INR control, by the following probable solutions; maintenance and monitoring of the (INR) to be within the optimal therapeutic target range in order to reduce the possibility of bleeding episodes, and encourage patients who are smoking to quit it at every possible visit to the clinic