Oral anticoagulation therapy: current challenges in Indian scenario

Abstract

Over the past decade, the burden of thromboembolic diseases has increased in India; however, there is a huge gap between the diagnosis and treatment of these ailments. This is further complicated by the presence of various options for anticoagulation therapy and the absence of a clinical consensus on the use of these anticoagulants. To address this issue and establish consensus statements on the use of anticoagulation therapy in Indian settings, an expert consensus was developed in alignment with the latest available evidence. A group of 38 clinical experts discussed, in detail, various case-based scenarios on stroke prevention in atrial fibrillation (AF), anticoagulation for patients with valvular heart disease, stroke, or deep-vein thrombosis. Anticoagulation management options for special populations, including patients with renal dysfunction, elderly patients, and pregnant women, were also discussed in detail. The key opinions the experts (cardiologists, cardiovascular and thoracic surgeons, consulting physicians, and neurologists) are intended to address gaps in Indian clinical practice concerning anticoagulation therapy. Based on scientific evidence, clinical experience, and guidelines on the use of anticoagulation therapy, various consensus statements were proposed. This document was drafted, reviewed, validated, and modified by the expert panel until a final agreement was reached. This pioneering consensus document will lay the foundation for future anticoagulation education modules based on evidence-based treatment approaches for Indian clinicians.

Analysis of Whole Blood Prothrombin Time/International Normalized Ratio Using Image Processing

“…POCs devices facilitates more frequent testing of anticoagulation levels which in turn improves time in Therapeutic Range (TTR) and reduces bleeding and thrombotic complications in patients on oral anticoagulation therapy [12]. Though there are various PT/INR monitoring devices are available, cost of consumables hinders their use in the developing countries like India [7].…”

“…It was also observed that values obtained in the devices were on the higher side compare to the POC device used. Not many studies have been conducted on the POC devices in the Indian population [7]. Studies have reported variation in the INR values of POC devices compared to laboratory tests specifically in the high range of INR above 3.5 [15][16][17].…”

“…This causes a huge burden on the clinical labs and discomfort to the patients as they have to travel long distances to check PT/INR. India has huge burden of CVD and we have a huge number of patients who needs oral anticoagulant therapy [7]. Most of the primary health centers, or even district hospitals in the urban areas in the country are not equipped with the PT monitoring devices; and there are logistic issues related to trained staff.…”