Is there a circannual variation in the anticoagulation control of warfarin?

Background: The literature regarding the seasonal variation in the therapeutic response to warfarin is somewhat contradictory, with several discrepancies. We assessed the influence of seasons on various pharmacodynamic indices of warfarin.

Methods: A retrospective study was carried out in adults receiving warfarin for at least 6 months. Details of their demographic characteristics, duration and dose of warfarin therapy and values of prothrombin time international normalised ratio (PT-INR) were retrieved. Standard definitions were followed for defining various seasons, time in therapeutic range (TTR), log-INR variability and warfarin sensitivity index (WSI). National Institute for Health and Care Excellence (NICE) criteria were used for defining TTR into good (≥65%) and poor (<65%) anticoagulation control.

Results: Two hundred and four patients were recruited. Only a subtle statistically significant difference was observed between the numbers of patients in the various PT-INR categories. However, no significant intra-individual differences were observed in mean TTR. Similarly, the proportion of patients with poor anticoagulation control, high INR variability and high WSI was not significantly different between summer, transition period 1, winter and transition period 2.

Conclusion: No clinically significant seasonal variations were observed in the therapeutic response to warfarin.