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THE CONTROL OF INTERNATIONAL NORMALISED RATIO IN PATIENTS WITH ATRIAL FIBRILLATION TREATED WITH WARFARIN IN OUTPATIENT AND HOSPITAL SETTINGS: DATA FROM RECVASA REGISTRIES

https://doi.org/10.20996/1819-6446-2018-14-1-40-46

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Abstract

Am. To study in the RECVASA registers the availability of data about the international normalized ratio (INR) indicator and achievement of its target values in outpatient and hospital practice in patients with atrial fibrillation (AF) receiving anticoagulant therapy with warfarin.

Material and methods. Data about the INR control and the frequency of achievement of its target values at the outpatient and hospital stages were analyzed in RECVASA (Ryazan) and RECVASA FP – Yaroslavl outpatient registries, as well as in the hospital registers RECVASA FP (Moscow, Kursk, Tula) in 817 patients (46.9% of men, age 68.5±9.6 years) with AF and the prescribed anticoagulant therapy with warfarin.

Results. INR was determined in 689 (84.3%) of 817 patients. The values of INR were monitored during therapy with warfarin in RECVASA (Ryazan) and RECVASA FP –Yaroslavl outpatient registries in 73.7% and 77.7% of patients, respectively, and in RECVASA FP hospital registers: 95.8% (Moscow); 81.3% (Tula) and 93.5% (Kursk). The target level of INR (2.0-3.0) was achieved in a minority of patients with AF during treatment with warfarin: inRyazan – in 26.3% of cases;Yaroslavl – 38.3%;Kursk – 34.8%;Moscow – 39.5%; Tule – 26.3%. Control of INR in hospital registries during warfarin therapy in patients with AF significantly more often (p<0.05) was performed at the hospital stage, compared with prehospital (in Kursk –2.3 times more often in Moscow – 2.6 times, in Tula – in 1,8 times). The target level of INR in the hospital was achieved significantly more often (p<0.05) than before hospitalization (Moscow andKursk), but no significant differences were found in the RECVASA FP –Tula register (p=0.08). The INR was monitored by 94.9% of the patients; however, the target values of this indicator were achieved only in 33% of cases in the sample study in the RECVASA FP –Moscow registry according to a survey of 39 patients with AF who continued to receive warfarin after 2.6±0.8 years after discharge from the hospital.

Conclusion. INR was monitored in 74-96% of patients with AF treated with warfarin and included in the RECVASA and RECVASA FP registries. Target levels of INR were achieved only in 26-39% of patients. INR was monitored with achievement of its target levels more often at the hospital stage of treatment than before hospitalization and more often than in outpatient registries. In practical public health in patients with AF treated with warfarin, it is fundamentally important to monitor INR and increase the frequency of achieving its target values, at which the risk of cardioembolic stroke and other thromboembolic complications is proven to be reduced.

About the Authors

M. M. Loukianov
National Medical Research Center for Preventive Medicine
Russian Federation

Michail M. Loukianov – MD, PhD, Head of Department of Clinical Cardiology and Molecular Genetics

Petroverigsky per. 10, Moscow, 101990



S. Yu. Martsevich
National Medical Research Center for Preventive Medicine
Russian Federation
Sergey Yu. Martsevich – MD, PhD, Professor, Head of Department of Preventive Pharmacotherapy


S. S. Yakushin
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation
Sergey S. Yakushin – MD, PhD, Professor, Head of Chair of Hospital Therapy


A. N. Vorobyev
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation
Alexander N. Vorobyev – MD, PhD, Assistant, Chair of Hospital Therapy


K. G. Pereverzeva
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation
Kristina G. Pereverzeva – MD, Assistant, Chair of Hospital Therapy


A. V. Zagrebelnyy
National Medical Research Center for Preventive Medicine
Russian Federation
Alexander V. Zagrebelnyy – MD, PhD, Senior Researcher, Department of Preventive Pharmacotherapy


V. Val. Yakusevich
Yaroslavl State Medical University
Russian Federation
Vladimir Val. Yakusevich – MD, PhD, Professor, Chair of Clinical Pharmacology


V. Vl. Yakusevich
Yaroslavl State Medical University
Russian Federation
Vladimir Vl. Yakusevich – MD, Postgraduate Student, Chair of Clinical Pharmacology


T. A. Gomova
Tula Regional Clinical Hospital
Russian Federation
Tatiana A. Gomova – MD, PhD, Deputy Chief Physician for General Issues


M. N. Valiakhmetov
Tula Regional Clinical Hospital
Russian Federation
Marat N. Valiakhmetov – MD, Deputy Chief Physician for Therapeutic Care


V. P. Mikhin
Kursk State Medical University
Russian Federation
Vadim P. Mikhin – MD, PhD, Professor, Head of Chair of Internal Medicine N2


Yu. V. Maslennikova
Kursk State Medical University
Russian Federation
Yulia V. Maslennikova – MD, Postgraduate Student, Chair of Internal Medicine N2


M. A. Bichurina
National Medical Research Center for Preventive Medicine
Russian Federation
Marina A. Bichurina – MD, cardiologist-resuscitator


L. A. Matskevich
National Medical Research Center for Preventive Medicine
Russian Federation
Ludmila A. Matskevich – MD, Head of Functional Diagnostics Department


E. N. Belova
National Medical Research Center for Preventive Medicine
Russian Federation
Ekaterina N. Belova – Programmer, Laboratory of Biostatistics


V. G. Klyashtorny
National Medical Research Center for Preventive Medicine
Russian Federation
Vladislav G. Klyashtorny – PhD (in Biology), Researcher, Laboratory of Biostatistics


E. V. Kudryashov
National Medical Research Center for Preventive Medicine
Russian Federation
Egor V. Kudryashov – Programmer, Laboratory of Biostatistics


A. D. Deev
National Medical Research Center for Preventive Medicine
Russian Federation
Alexander D. Deev – PhD (in Physics and Mathematics), Head of Laboratory of Biostatistics


O. M. Drapkina
National Medical Research Center for Preventive Medicine
Russian Federation
Oksana M. Drapkina – MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director


s. A. Boytsov
National Medical Research Center of Cardiology
Russian Federation
Sergey A. Boytsov – MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, General Director


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For citation:


Loukianov M.M., Martsevich S.Y., Yakushin S.S., Vorobyev A.N., Pereverzeva K.G., Zagrebelnyy A.V., Yakusevich V.V., Yakusevich V.V., Gomova T.A., Valiakhmetov M.N., Mikhin V.P., Maslennikova Y.V., Bichurina M.A., Matskevich L.A., Belova E.N., Klyashtorny V.G., Kudryashov E.V., Deev A.D., Drapkina O.M., Boytsov s.A. THE CONTROL OF INTERNATIONAL NORMALISED RATIO IN PATIENTS WITH ATRIAL FIBRILLATION TREATED WITH WARFARIN IN OUTPATIENT AND HOSPITAL SETTINGS: DATA FROM RECVASA REGISTRIES. Rational Pharmacotherapy in Cardiology. 2018;14(1):40-46. (In Russ.) https://doi.org/10.20996/1819-6446-2018-14-1-40-46

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ISSN 1819-6446 (Print)
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