Abstract
Background: Warfarin, a commonly prescribed oral anticoagulant, relies
on maintaining effective therapeutic levels as measured by the time
within therapeutic range (TTR) and international normalized ratio (INR).
However, the narrow therapeutic index of warfarin, influenced by both
genetic and non-genetic factors, poses a significant risk of bleeding or
coagulation complications. Identifying predictors of stable INR levels
in warfarin-naïve patients is crucial to improve treatment safety and
efficacy. Methods: This retrospective study conducted between 2018 and
2021 at Queen Alia Hospital Institute QAHI – RMS aimed to identify the
impact of patient demographics, co-morbidities, and drug-drug
interactions on stable, sub-therapeutic, and supra-therapeutic INR
readings. Additionally, the study sought to determine risk factors for
warfarin toxicity and major bleeding events associated with warfarin
treatment. Results: Medical records of 163 warfarin-naïve patients (103
males, 60 females) with a baseline INR ≤1.2 were analyzed. Patients were
admitted as emergency cases or transferred from internal medicine to the
warfarin clinic. The majority of patients were under 65 years of age,
overweight, and received warfarin for heart valve replacement or atrial
fibrillation. Polypharmacy was common among the patients. Analysis
revealed both good responders (24.5%) and poor responders (75.5%) in
terms of TTR%. Conclusion: Predictors of warfarin anticoagulation may
include age, gender, smoking status, and concomitant medication use.
Considering these factors when managing warfarin therapy can improve
treatment outcomes and patient safety.