Estimating Time in Therapeutic Range in Cardiology and Neurology Patients on Warfarin/Acenocoumarol: Assessing its Association with Clinical Outcomes and Influencing Factors for it’s Reliable Use in General Practice

ABSTRACT: Anticoagulant therapy is a cornerstone in the management of various cardiovascular and neurological disorders as it can impose high risk of thromboembolic events. Time in Therapeutic Range (TTR) is a key indicator of anticoagulant therapy by measuring how often a patient’s INR remains within the target range to ensure the safe use of oral anticoagulant therapy.The cohort study involved 110 outpatients in the department of cardiology (n=80) and neurology (n=30) who were on oral anticoagulant treatment (WARFARIN/ACENOCOUMAROL) for not <6 months. Rosendaal’s linear interpolation method was used to calculate TTR with TTR ≥ 60% indicating good control and TTR < 60% as poor control. The data on clinical events such as alopecia, gum bleeding, and allergic reactions and factors influencing TTR were collected through patient interactions and medical records.In cardiology, 57.5% of patients had TTR<60% and had a higher incidence of adverse clinical effects when compared to neurology patients where the distribution was more balanced and clinical events were less frequent. Average monthly doses were 7±2.31 mg of Warfarin and 2.5±1.45 mg of Acenocoumarol in cardiology, and 1.98±0.62 mg of Acenocoumarol in neurology. The findings reveal that while body weight shows a significant association with TTR (p<0.002), other variables such as age, gender, and co morbidities did not exhibit strong statistical correlations. Importantly, there was no significant link between TTR and the occurrence of adverse effects, suggesting that factors beyond TTR may play a critical role in clinical outcomes.