Purpose: An audit was conducted to determine if the benefits of dabigatran treatment, as demonstrated in the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial, are applicable to patients with nonvalvular atrial fibrillation managed by a pharmacist-run anticoagulation clinic (PAC).
Methods: The records of warfarin-treated patients managed by a PAC program over a three-year period were screened to identify patients with diagnosed nonvalvular atrial fibrillation and a goal International Normalized Ratio (INR) of 2-3; the case selection criteria were similar to those used in the RE-LY trial. Abstracted data included dates and results of INR monitoring and information needed to calculate CHADS2 (Congestive Heart Failure, Hypertension, Age, Diabetes, and Stroke [doubled]) scores. Warfarin time in the therapeutic range (TTR) was the primary endpoint. A pairwise comparison of TTR distributions in subsets of patients grouped by CHADS2 score was performed to test the hypothesis that any two groups had identical distributions.
Results: Data on 314 PAC patients, including 9772 INR values, were analyzed. The mean±S.D. TTR was 62.4%±24.5% (median, 66.7%), which was similar to the mean TTR reported in the RE-LY trial (p=0.092). The distribution of TTR values in the PAC population differed significantly in patients with a CHADS2 score of 2 versus a score of 3 (p=0.0333 for Kuiper test), but no other significant differences were noted.
Conclusion: TTR values among PAC-managed patients with nonvalvular atrial fibrillation were comparable to those reported in the RE-LY trial.
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