New Approaches to Individualized Choice of Oral Anticoagulants in Patients With Atrial Fibrillation

Skirdenko, Ju. P.; Nikolayev, N. A.

doi:10.20996/1819-6446-2018-14-1-58-64

Cited by 4 publications

(2 citation statements)

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“…В последние годы производство и потребление антикоагулянтных препаратов стремительно растет [13,14]. Варфарин, при его известных ограничениях (сложность изначального подбора дозы, необходимость постоянного мониторирования МНО [5], изменение антикоагулянтной активности при употреблении широкого спектра пищевых продуктов и Drug Interactions for Warfarin Межлекарственное взаимодействие варфарина лекарственных препаратов [15,16]) остается одним из самых популярных.…”

Section: Discussionunclassified

Decrease in Efficacy of Warfarin as a Result of Drug-Drug Interaction (Case Report)

Ватутин

Тарадин

Игнатенко

et al. 2020

Racionalʹnaâ farmakoterapiâ v kardiologii

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The one of the main aims in modern clinical pharmacology is to provide safe and effective therapy considering a frequent administration of several drugs having different drug-drug interactions. Warfarin belongs to the number of popular anticoagulants which along with its efficiency not infrequently alters anticoagulant characteristics when administered with other drugs and food products. A case of a decrease in the efficacy of warfarin in a patient with mitral stenosis while taking a combined choleretic drug is presented in the article. The components of this choleretic drug (dry animal bile, dry garlic extract, dry nettle extract, activated charcoal) could impair the absorption of warfarin, increase intestinal absorption of vitamin K, and have a negative effect on the anticoagulant effect of warfarin. Management of patients receiving anticoagulants should be performed in accordance with clinical recommendations. Prescription of drugs, including multicomponent ones, without proven efficacy, for such patients should be considering the potential drug interaction.

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Section: Discussionunclassified

Decrease in Efficacy of Warfarin as a Result of Drug-Drug Interaction (Case Report)

Ватутин

Тарадин

Игнатенко

et al. 2020

Racionalʹnaâ farmakoterapiâ v kardiologii

View full text Add to dashboard Cite

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“…Учитывая, что сочетание недостаточной приверженности и небезопасного в отношении варфарина рациона делает риск терапии крайне высоким, мы предлагаем рассмотреть оценку риска пищевых взаимодействий в качестве одного из наиболее существенных факторов, влияющих на принятие решений о назначении варфарина пациентам с недостаточной приверженностью модификации образа жизни [29].…”

Section: рис 2 вопросник оценки индивидуального риска пищевых взаимодействий у пациента принимающего варфарин (фрагмент)unclassified

Assessment of individual risk of food interactions while taking warfarin

Skirdenko

Николаев

Анатольевич³

2021

Terapevticheskii arkhiv

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Aim. To develop a questionnaire to assess the individual risk of food interactions in a patient taking warfarin. Materials and methods. Based on the review of 159 literature sources, a test version of the questionnaire was formed. 196 respondents took part in the pilot part of the study to assess the multiplicity and volume of food consumption. For the initial assessment of the risk limit of the diet, complications of warfarin therapy were registered no earlier than 24 weeks later. Results. The final version of the questionnaire included 25 products that are most frequently consumed and significant in relation to the risk of alimentary interactions. The questionnaire contains 2 groups of products: increasing and decreasing the activity of warfarin. The volume and frequency of use of each product is evaluated in points that are calculated as the simple product of weights of frequency and volume, with a minimum value of 0 and maximum of 12. The number of points for each product is calculated separately. The points obtained are summed for a group of products that increase the activity of warfarin, and for a group of products that reduce it, and the overall risk score is calculated. The average number of points for the use of products that affect the activity of warfarin in patients with AF with complications of therapy was 75.7831.97 b. The calculation of the design validity of the questionnaire (Cronbachs a=0.864) showed a good level for confirmation purposes. Conclusion. A specialized questionnaire was developed, implemented as a computer program, to assess the significance of food preferences in ensuring the safety and effectiveness of warfarin therapy. Further research is required to determine the risk limit of alimentary interactions of warfarin, but now this questionnaire can be used to monitor the uniformity of consumption of products that affect its activity. The authors suggested using a questionnaire for assessing the risk of food interactions as one of the factors influencing the decision to prescribe warfarin to patients with insufficient adherence to lifestyle modification.

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Algorithm for the Choice of Anticoagulant for Patients with Atrial Fibrillation

Skirdenko

Николаев

2020

Racionalʹnaâ farmakoterapiâ v kardiologii

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Aim. To evaluate the effectiveness of the anticoagulant choice algorithm in the prevention of complications of atrial fibrillation (AF). Material and methods. Patients with AF (n=98) were included into observational prospective study. The level of adherence to treatment, risk of food interactions and presence of CYP2C9 and VKORC1 genes mutations were determined at the initial examination. These indicators were necessary to specify an eligible anticoagulant according to the evaluated algorithm. Therapy was prescribed by the attending physician. Hemorrhagic and thromboembolic complications were assessed at the next examination after 24 weeks. Results. Hemorrhagic complications were observed in 31.6% of patients during the follow-up. Their number was comparable in individuals taking antiplatelet agents and direct oral anticoagulants (DOACs) (χ2=1.44; p<0.49, Pearson) and significantly more in individuals taking warfarin (as compared to DOACs: χ2=25.08; p<0.000, Pearson; and antiplatelet agents: χ2=34.32; p<0.000, Pearson). Thromboembolic complications were reported in 8.16% of patients. Their number was more in patients taking DOACs than warfarin (χ2=7.03; p<0.03, Pearson). Patients who had to take DOACs according to the algorithm, but in the study took warfarin, demonstrated significantly greater number of thromboembolic complications, with a comparable number of hemorrhagic complications. Patients who could take warfarin according to the algorithm, but in the study took DOACs, had significantly greater number of thromboembolic complications, with a comparable number of hemorrhagic complications. Conclusion. The results of the study demonstrated the potential for reduction in complications, especially thromboembolic, in the choice of anticoagulant using the algorithm; and reduction in complications of therapy, primarily with warfarin, due to the initial prescription of DOACs. The proposed approach, which consists in using the quantitative assessment of adherence to treatment, and only if necessary supplemented by the assessment of food preferences and/or pharmacogenetic studies, contributes to the treatment optimization.

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New Approaches to Individualized Choice of Oral Anticoagulants in Patients With Atrial Fibrillation

Cited by 4 publications

References 4 publications

Decrease in Efficacy of Warfarin as a Result of Drug-Drug Interaction (Case Report)

Decrease in Efficacy of Warfarin as a Result of Drug-Drug Interaction (Case Report)

Assessment of individual risk of food interactions while taking warfarin

Algorithm for the Choice of Anticoagulant for Patients with Atrial Fibrillation

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