الفهرس 
Vitamin k antagonist (Warfarin)Only 14 pages are availabe for public view
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Abstract
Vitamin K antagonists (VKAs), although no longer the only option, remain the pharmaceutical group more widely employed, due to their relatively low price and large amount of experience. Coagulation status with VKAs needs to be monitored carefully to ensure maximal efficacy with minimal complication rates. The international normalized ratio INR is used to express the coagulation state, and the maximum efficacy is from 2 to 3. Several formulas have been proposed to assess the quality of anticoagulation. Among those formulas, the time in the therapeutic range (TTR) is the more extended and has proven to be a major determinant of the efficacy and safety of anticoagulation with VKAs. The estimated time spent in the TTR is assessed by the Rosendaal method.
Our study aimed to Study the INR values in patients on VKAs in the selected area , Find out which patient characteristics that are associated with good INR control and Calculation of the time in the therapeutic range (TTR) when is possible according to the number of INR/Patient.
This is a Cross section observational study that was be conducted at cardiology department at Benha University Hospital after approval of the local ethical committee with a total number of 200 cases who were divided into two groups , sub group I with TTR ≥ 65% ( n = 93 ) and sub group II with TTR < 65% ( n = 107 ).
In our study , the sub group I (TTR ≥ 65%) were younger in age , more male , highly educated , lower Stroke and hemorrhagic risks , lower comorbid diseases than sub group II (TTR<65%).
Multivariate analysis was done to see the significant independent predictors for a good INR control i.e. TTR ≥ 65%. The dependent factor was TTR ≥ 65%.
The independent factors were:
• Age (as a continuous variable).
• Gender – as categorical variable.
• Education level - as categorical variable.
• Presence or absence of CKD - as categorical variable.
• Presence or absence of chronic hepatic disease – as categorical variable.
• CHADS-VASc2 score (as a continuous variable).
• HAS-BLED score (as a continuous variable).
It was found that high level of education compared to lower levels is the only significant independent predictor for obtaining good INR control ( P value < 0.001)
In Our study, the rate of inadequate control with VKAs ( TTR<65 ) is 52%.