ISSN : 2146-3123
E-ISSN : 2146-3131

The Prevalence and Risks of Inappropriate Combination of Aspirin and Warfarin in Clinical Practice: Results From WARFARIN-TR Study
Salih Kılıç1, Ahmet Çelik2, Elif Çekirdekçi3, Servet Altay4, Deniz Elçik5, Mehmet Kadri Akboğa6, Mine Durukan7, Çağrı Yayla6, Mehdi Zoghi1, WARFARIN-TR Study Group
1Department of Cardiology, Ege University School of Medicine, İzmir, Turkey
2Department of Cardiology, Mersin University School of Medicine, Mersin, Turkey
3Clinic of Cardiology, Tekirdağ Çorlu District State Hospital, Tekirdağ, Turkey
4Clinic of Cardiology, Edirne Sultan Murat 1. State Hospital, Edirne, Turkey
5Clinic of Cardiology, Ankara Research and Training Hospital, Ankara, Turkey
6Clinic of Cardiology, Turkey Yüksek İhtisas Hospital, Ankara, Turkey
7Clinic of Cardiology, Mersin City Research and Training Hospital, Mersin, Turkey
DOI : 10.4274/balkanmedj.2017.1472

Background: The use of warfarin and aspirin combination is restricted for limited patients in relevant guidelines.
Aims: The aim of this study is to evaluate the prevalence of inappropriate combination of aspirin and warfarin therapy in daily practice and its risks.
Study Design: Cross-section study.
Methods: WARFARIN-TR study is a multi-center observational study that includes 4987 patients using warfarin for any reason between January 1, 2014 and December 31, 2014. To determine the prevalence of inappropriate combination use in daily practice, all patients who had a history of atherosclerotic disease (ischemic heart disease, peripheral artery disease) or cerebrovascular disease (n=1498) were excluded. The data of 3489 patient were analyzed. We defined inappropriate combination, all patients who received aspirin and warfarin regardless of warfarin use indication, in the direction of the ESC guidelines recommendation.
Results: The mean age of the patients was 59.2±13.8 years (41.8% male). The prevalence of inappropriate warfarin and aspirin combination was found as 20.0%. The prevalence of combination therapy in patients with a primary indication for mechanical heart valve, non-valvular atrial fibrillation MHV, and other reason was 20.5%, 18.7% and 21.0%, respectively. Multivariate logistic regression analysis revealed that age (OR, 1.009; 95% CI, 1.002-1.015; p=0.010), HF (OR, 1.765; 95% CI, 1.448-2.151; p<0.001), smoking (OR, 1.762; 95% CI, 1.441-1.153; p<0.010), CKD (OR, 2.057; 95% CI, 1.494-2.833; p<0.001), and deep vein thrombosis (OR, 0.463; 95% CI, 0.229-0.718; p=0.001) were independent predictors of the combination therapy (R2=0.66 ). The mean Time in Therapeutic Range (TTR) of patients receiving combination therapy was significantly lower than those in warfarin mono-therapy (51.6±27.05 vs. 54.7±23.93; p=0.006). Totally, 19.4% (n=677) of the patients had a bleeding event (major bleeding 13.0%, n=88) within a year. Percentages of patients with combination therapy were significantly higher in patients with major bleeding than patients without major bleeding (29.5% vs. 19.7%; P=0.023).
Conclusion: Our study demonstrated that 20.0% of the patients taking warfarin use concomitant aspirin inappropriately in daily practice. Patients receiving aspirin with warfarin were demonstrated to have more comorbidities, lower TTR levels, and higher rates of bleeding.

Keywords : RNA-Sequencing, plasma cell dyscrasias, flow cytometry, myeloma cells
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