Can we predict daily adherence to warfarin? Results from the international normalized ratio adherence and genetics (IN-RANGE) study

Alec B. Platt, A. Russell Localio, Colleen M. Brensinger, Dean G. Cruess, D. Christie, Robert Gross, Catherine S. Parker Maureen- Price, Joshua P. Metlay, Abigail Cohen, Craig W. Newcomb, Brian L. Strom, Mitchell S. Laskin, Stephen E. Kimmel

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

Background: Warfarin is the primary therapy to prevent stroke and venous thromboembolism. Significant periods of nonadherence frequently go unreported by patients and undetected by providers. Currently, no comprehensive screening tool exists to help providers assess the risk of nonadherence at the time of initiation of warfarin therapy. Methods: This article reports on a prospective cohort study of adults initiating warfarin therapy at two anticoagulation clinics (university- and Veterans Affairs-affiliated). Nonadherence, defined by failure to record a correct daily pill bottle opening, was measured daily by electronic pill cap monitoring. A multivariable logistic regression model was used to develop a point system to pre-dict daily nonadherence to warfarin. Results: We followed 114 subjects for a median of 141 days. Median nonadherence of the partici-pants was 14.4% (interquartile range [IQR], 5.8-33.8). A point system, based on nine demographic, clinical, and psychosocial factors, distinguished those demonstrating low vs high levels of nonad-herence: four points or fewer, median nonadherence 5.8% (IQR, 2.3-14.1); five points, 9.1% (IQR, 5.9-28.6); six points, 14.5% (IQR, 7.1-24.1); seven points, 14.7% (IQR, 7.0-34.7); and eight points or more, 29.3% (IQR, 15.5-41.9). The model produces a c-statistic of 0.66 (95% CI, 0.61-0.71), suggesting modest discriminating ability to predict day-level warfarin nonadherence. Conclusions: Poor adherence to warfarin is common. A screening tool based on nine demographic, clinical, and psychosocial factors, if further validated in other patient populations, may help to identify groups of patients at lower risk for nonadherence so that intensified efforts at increased monitoring and intervention can be focused on higher-risk patients.

Original languageEnglish (US)
Pages (from-to)883-889
Number of pages7
JournalCHEST
Volume137
Issue number4
DOIs
StatePublished - Apr 1 2010

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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