Therapeutic itinerary: trajectory for resolution of adverse events of patients using warfarin in Southern Brazil

Abstract

Warfarin is the most used anticoagulant in primary health care. Due to the narrow therapeutic index, its users are more susceptible to adverse events. The objective of this study was to describe the itinerary of the public health sector patients for resolution of adverse events related to warfarin. It is a prospective open cohort, held for a period of 18 months with warfarin users of the Brazilian public health system. Data were collected by monthly interviews and from patient records. Results: Sixty nine patients were interviewed, 64 of them completed monitoring and five died. Bleeding and venous thromboembolism were more frequent in patients starting treatment. It was observed that when adverse events have occurred, in most cases the patient held self-care at home (57%). During the follow-up, five patients were hospitalized for bleeding. Approximately half of the patients did not present their INR exams to the doctor. Conclusions: This study demonstrates weaknesses in caring for these patients and the need to accompany them, aiming to standardize and guide the itinerary of the anticoagulated patient to solve their problems and improve safety in drug treatment, with less cost to the public health system.

Polymorphism of the CYP2C9 and VKORC1 genes in patients on the public health system of a municipality in Southern Brazil

“…The complete sociodemographic data are described in Colet, Amador, and Heineck. 6 …”

“…The complete sociodemographic data are described in Colet, Amador, and Heineck. 6 Participants used an average of 10.5 ± 3.4 continuous use drugs, including warfarin. The most frequent reason for warfarin use was prosthetic heart valves (39.7%), followed by treatment or prevention of venous thromboembolism (36.3%).…”

“…Data related to drug interactions and adverse events 5 have been published and data on patients’ therapeutic itineraries have also been published. 6 …”

“…These outcomes were self-reported and confirmed in medical records for cases in which the user sought medical care on the municipal care network. Details on patient identification, patient inclusion and information collection are described in Colet et al 6 …”

“…These outcomes were self-reported and confirmed in medical records for cases in which the user sought medical care on the municipal care network. Details on patient identification, patient inclusion and information collection are described in Colet et al 6 Samples were also collected for laboratory tests at the participants' homes in the third, tenth and, eighteenth months of the study. The results of INR (international normalized ratio) tests were used to calculate the time that patients taking warfarin remained in the therapeutic range (TTR), employing validated methodology adapted by Schmidt, Speckman, and Ansell.…”