A Prospective Study on the Use of Warfarin in the United Arab Emirates

OBJECTIVES The aims of this study were to evaluate adherence of patients and medical staff to warfarin guidelines and assess clinical outcome and predictors of treatment failure. METHODS This cross-sectional survey involved out- and in-patient subjects receiving warfarin. Patient attentiveness, compliance, co-morbidities, complications, and international normalized ratio (INR) as well as adherence of medical staff to established warfarin treatment guidelines were recorded. RESULTS One-hundred-sixty patients were recruited (mean ± SD age = 54 ± 1.3 years; 46% males; 77% overweight/obese). Indications for warfarin were atrial fibrillation (35%), deep vein thrombosis (28%), prosthetic heart valve (20%) and stroke or dilated cardiomyopathy (12%). "Warfarin booklets" were made available to 25% of the patients, and ~80% of the recipients reported inadequate understanding of its content. INR was strictly monitored in 23% of the patients; ~70% never received Information Leaflets; ~88% were unaware of warning labels; and ~58% were unaware that over-thecounter medications may affect warfarin. Therapeutic INR (2.9 ± 0.2; 76 days) was achieved in 73%; 20% had high INR (3.7 ± 0.1; 18.6 days) and 7% had low INR (1.6 ± 0.1; 16.7 days). Of the patients with high INR, 2.5% had major bleeding events. Of the patients with low INR, 5% had thromboembolic events. Poor compliance and co-morbidities were associated with adverse events (p=0.01). CONCLUSIONS Attentiveness and adherence to warfarin treatment and monitoring guidelines are suboptimal among patients and medical staff. Novel strategies are necessary to alert patients, pharmacists and physicians on the seriousness of warfarin treatment failure.