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Pre-analytical variations affecting INR measurement for dose tailoring of anticoagulants.
Although warfarin (WRN) has been used as oral anticoagulant therapy for over 60 years, it remains a challenge to use in clinical practice since several factors may complicate WRN response which expressed is in international normalized ratio (INR). Numerous patient related variations may affect the a...
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2019
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| _version_ | 1867613410533834752 |
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| access_status_str | Open Access |
| author | Shamma, Samir Nabhan |
| author_browse | Shamma, Samir Nabhan |
| author_facet | Shamma, Samir Nabhan |
| author_sort | Shamma, Samir Nabhan |
| collection | Thesis |
| dc_rights_str_mv | The author retains all rights with regard to copyright. The author certifies that written permission from the owner(s) of third-party copyrighted matter included in the thesis, dissertation, paper, or record of study has been obtained. The author further certifies that IRB approval has been obtained for this thesis, or that IRB approval is not necessary for this thesis. Insofar as this thesis, dissertation, paper, or record of study is an educational record as defined in the Family Educational Rights and Privacy Act (FERPA) (20 USC 1232g), the author has granted consent to disclosure of it to anyone who requests a copy. |
| description | Although warfarin (WRN) has been used as oral anticoagulant therapy for over 60 years, it remains a challenge to use in clinical practice since several factors may complicate WRN response which expressed is in international normalized ratio (INR). Numerous patient related variations may affect the adequacy of the assay interpretation which may lead to into poor clinical management. This study aims investigating the impact of age, sex, hemoglobin, packed cell volume (PCV), and albumin levels as well as patient adherence and drug-drug interactions (DDI) on coagulation monitoring results. INR was recorded in patients under WRN maintenance therapy (n=96). Hemoglobin, PCV and albumin levels were recorded. Patient adherence to WRN regimen was analytically assessed using an LC-MS/MS method. In the study group, 45% achieved the target INR (2 – 3.5). Anemia was more prevalent among uncontrolled patients where 38% suffered severe anemia (5 male and 15 female). Abnormal PCV was observed in 47% of uncontrolled patients (7 male and 18 female). There was a significant difference in age, hemoglobin, and PCV and albumin level between patients who achieved optimum INR and those who did not. Moreover, good relationship was obtained between WRN concentration and INR (R2=0.622) by excluding samples showing DDI (n=16), abnormal albumin (n=9) or steroid (n=6) abnormalities. Analytical assessment revealed lack of adherence to WRN dose. In addition, unsupervised drug consumption or missing prescribed doses was observed in at least 5% of the cases. In conclusion, based on the poor correlation of INR with plasma WRN in these cases, albumin level, hemoglobin, and PCV abnormalities along with DDI are all important factors to consider during clinical monitoring of WRN response. It also highlights the significance of monitoring plasma WRN to assess adherence to scheduled doses. These findings may help to identify the patients who will require closer monitoring for optimizing the outcomes of WRN therapy. |
| format | Thesis |
| id | oai:fount.aucegypt.edu:etds-1515 |
| institution | American University in Cairo (Egypt) |
| last_indexed | 2026-06-10T12:35:42.290Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from AUC Knowledge Fountain — bepress |
| publishDate | 2019 |
| publishDateRange | 2019 |
| publishDateSort | 2019 |
| publisher | AUC Knowledge Fountain |
| publisherStr | AUC Knowledge Fountain |
| record_format | dspace |
| source_str | AUC Knowledge Fountain — bepress |
| spelling | oai:fount.aucegypt.edu:etds-1515 Pre-analytical variations affecting INR measurement for dose tailoring of anticoagulants. Shamma, Samir Nabhan Although warfarin (WRN) has been used as oral anticoagulant therapy for over 60 years, it remains a challenge to use in clinical practice since several factors may complicate WRN response which expressed is in international normalized ratio (INR). Numerous patient related variations may affect the adequacy of the assay interpretation which may lead to into poor clinical management. This study aims investigating the impact of age, sex, hemoglobin, packed cell volume (PCV), and albumin levels as well as patient adherence and drug-drug interactions (DDI) on coagulation monitoring results. INR was recorded in patients under WRN maintenance therapy (n=96). Hemoglobin, PCV and albumin levels were recorded. Patient adherence to WRN regimen was analytically assessed using an LC-MS/MS method. In the study group, 45% achieved the target INR (2 – 3.5). Anemia was more prevalent among uncontrolled patients where 38% suffered severe anemia (5 male and 15 female). Abnormal PCV was observed in 47% of uncontrolled patients (7 male and 18 female). There was a significant difference in age, hemoglobin, and PCV and albumin level between patients who achieved optimum INR and those who did not. Moreover, good relationship was obtained between WRN concentration and INR (R2=0.622) by excluding samples showing DDI (n=16), abnormal albumin (n=9) or steroid (n=6) abnormalities. Analytical assessment revealed lack of adherence to WRN dose. In addition, unsupervised drug consumption or missing prescribed doses was observed in at least 5% of the cases. In conclusion, based on the poor correlation of INR with plasma WRN in these cases, albumin level, hemoglobin, and PCV abnormalities along with DDI are all important factors to consider during clinical monitoring of WRN response. It also highlights the significance of monitoring plasma WRN to assess adherence to scheduled doses. These findings may help to identify the patients who will require closer monitoring for optimizing the outcomes of WRN therapy. 2019-02-01T08:00:00Z thesis text/html https://fount.aucegypt.edu/etds/516 https://fount.aucegypt.edu/context/etds/article/1515/type/native/viewcontent/samir_20thesis_20final_20version_202018.pdf_sequence_1 The author retains all rights with regard to copyright. The author certifies that written permission from the owner(s) of third-party copyrighted matter included in the thesis, dissertation, paper, or record of study has been obtained. The author further certifies that IRB approval has been obtained for this thesis, or that IRB approval is not necessary for this thesis. Insofar as this thesis, dissertation, paper, or record of study is an educational record as defined in the Family Educational Rights and Privacy Act (FERPA) (20 USC 1232g), the author has granted consent to disclosure of it to anyone who requests a copy. Theses and Dissertations AUC Knowledge Fountain Warfarin Anticoagulation |
| spellingShingle | Warfarin Anticoagulation Shamma, Samir Nabhan Pre-analytical variations affecting INR measurement for dose tailoring of anticoagulants. |
| title | Pre-analytical variations affecting INR measurement for dose tailoring of anticoagulants. |
| title_full | Pre-analytical variations affecting INR measurement for dose tailoring of anticoagulants. |
| title_fullStr | Pre-analytical variations affecting INR measurement for dose tailoring of anticoagulants. |
| title_full_unstemmed | Pre-analytical variations affecting INR measurement for dose tailoring of anticoagulants. |
| title_short | Pre-analytical variations affecting INR measurement for dose tailoring of anticoagulants. |
| title_sort | pre analytical variations affecting inr measurement for dose tailoring of anticoagulants |
| topic | Warfarin Anticoagulation |
| url | https://fount.aucegypt.edu/etds/516 https://fount.aucegypt.edu/context/etds/article/1515/type/native/viewcontent/samir_20thesis_20final_20version_202018.pdf_sequence_1 |
| work_keys_str_mv | AT shammasamirnabhan preanalyticalvariationsaffectinginrmeasurementfordosetailoringofanticoagulants |