Is warfarin more stable than fluindione? A retrospective study in primary care (STAB-VKA study)
Quach Hiep, Thanh Tam
Is warfarin more stable than fluindione? A retrospective study in primary care (STAB-VKA study) - 2022.
99
Despite their second-line prescription after direct oral anticoagulants (DOACs), vitamin K antagonists (VKAs) are widely used in primary care. In France, fluindione accounted for 82% of the VKAs prescribed in 2016 compared to 13% for warfarin. However, warfarin is the standard drug elsewhere in the world and its longer half-life should make it more suitable with more stable International Normalized Ratios (INRs). The objectives of our study were to compare these two drugs in terms of both their long-term anticoagulant effect stability and of the frequency of biological checks of the INRs performed. A retrospective exposed/non-exposed study based on data from an Orne (France) blood examination laboratory was conducted on adult patients treated with fluindione or warfarin from January 1, 2014 to December 31, 2016, whatever the indication. Treatment stability was assessed using the time in therapeutic range (TTR), calculated using the Rosendaal method from the INRs measured in routine practice. Comparisons between the two groups were made using multilevel linear regression with univariate and then multivariate analysis with adjustment for age, sex, and kidney function. 204 patients were included (77.0±10.0 years-old, females 49.5 %), 170 treated with fluindione and 34 with warfarin. The mean TTR with fluindione was 68.0 % versus 72.0 % with warfarin (p=0.085). The mean time between two INRs was 22.8 days with fluindione versus 31.1 days with warfarin (p=0.049). Compared to fluindione, warfarin seems to provide quality-of-life benefit for patients. Despite our results, we recommend that warfarin should be preferred over fluindione in primary care.
Is warfarin more stable than fluindione? A retrospective study in primary care (STAB-VKA study) - 2022.
99
Despite their second-line prescription after direct oral anticoagulants (DOACs), vitamin K antagonists (VKAs) are widely used in primary care. In France, fluindione accounted for 82% of the VKAs prescribed in 2016 compared to 13% for warfarin. However, warfarin is the standard drug elsewhere in the world and its longer half-life should make it more suitable with more stable International Normalized Ratios (INRs). The objectives of our study were to compare these two drugs in terms of both their long-term anticoagulant effect stability and of the frequency of biological checks of the INRs performed. A retrospective exposed/non-exposed study based on data from an Orne (France) blood examination laboratory was conducted on adult patients treated with fluindione or warfarin from January 1, 2014 to December 31, 2016, whatever the indication. Treatment stability was assessed using the time in therapeutic range (TTR), calculated using the Rosendaal method from the INRs measured in routine practice. Comparisons between the two groups were made using multilevel linear regression with univariate and then multivariate analysis with adjustment for age, sex, and kidney function. 204 patients were included (77.0±10.0 years-old, females 49.5 %), 170 treated with fluindione and 34 with warfarin. The mean TTR with fluindione was 68.0 % versus 72.0 % with warfarin (p=0.085). The mean time between two INRs was 22.8 days with fluindione versus 31.1 days with warfarin (p=0.049). Compared to fluindione, warfarin seems to provide quality-of-life benefit for patients. Despite our results, we recommend that warfarin should be preferred over fluindione in primary care.
Réseaux sociaux