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Patients on chronic warfarin therapy who have poor anticoagulation control are at increased risk for adverse events. The aim of this study was to examine the relationship between patient educational level (EL) and anticoagulation control as measured by ‘International Normalized Ratio (INR)’.
139 patients (mean age 65.9±10.4 years) who had visited the outpatient cardiology clinic of a university hospital while receiving warfarin were investigated. Patients with cognitive or neurological deficits were excluded. Demographic and clinical data (including anticoagulation indication and duration, target INR range, and last 6 INR values) were collected. Good anticoagulation control (GAC) was defined as achieving target INR value in at least ≥60% of measurements. Patients were grouped according to their EL as illiterate (group 1, n=34), ≤5 years of education (group 2, n=66), >5 years of education (group 3, n=39).
The majority of patients were female (n=86, 62.3%), and the most frequent warfarin indication was nonvalvular atrial fibrillation (n=116, 84%). Most patients (80%) have been treated for at least 1 year. Only 44.6% of participants had good anticoagulation control. Patients in group 1 were older (71.4±8.9 vs. 62.2±11.2, p<0.001) and more likely to be female (76.5% vs. 51.3%, P=0.023), compared to group 3. There were no differences regarding warfarin indication and duration of therapy between groups (p=0.118, and p=0.413 respectively). There was no significant relationship between EL and anticoagulation control (p=0.464).
Although there was tendency of better anticoagulation control in the educated patients (Group 3) this is not reach to a significant level. It is obvious that anticoagulation control remains to be improved.
n = 34
n = 66
n = 39
|Age||71.4 ± 8.9||65.3 ± 9.5||62.2 ± 11.2||< 0.001|
|Female (%)||26 (76.5)||41 (62.1)||20 (51.3)||0.085|
|Nonvalvular AF (%)||32 (94.1)||49 (77.8)||29 (80.6)||0.118|
|GAC||13 (38.2)||30 (45.5)||19 (48.7)||0.656|
|Duration of warfarin treatment (months)||34.0 ± 29.8||42.9 ± 48.1||49.2 ± 40.7||0.413|