ISSN: 1859 - 2872
Utilization of vitamin K antagonists among outpatients covered by health insurance at 108 Military Central Hospital (2024-2025)
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Abstract
This descriptive, longitudinal retrospective study was conducted on 102 outpatients receiving health insurance-covered vitamin K antagonist (VKA) therapy at 108 Military Central Hospital during the 2024-2025 period to evaluate prescribing patterns and VKA treatment efficacy. Results showed a mean age was 68.2 ± 11.2 years, with atrial fibrillation being the predominant indication (63.7%). During anticoagulation therapy, 69.7% of patients switched between VKAs and direct oral anticoagulants (DOACs). The mean weekly acenocoumarol dose was low, at 8.9 ± 6.2mg. Regarding dose adjustments, regimens were preferentially maintained during minor INR fluctuations (< 0.5 units from the target). However, the rate of keeping the dose unchanged despite significant deviations (> 0.5 units) from the target remained high (63.8% of subtherapeutic, 46.7% of supratherapeutic INRs). The mean magnitude of weekly dose increases and decreases was 36.8 ± 33.9% and 25.7 ± 22.5%, respectively. The mean time in therapeutic range (TTR) was 25.5 ± 25.9%, with 6.5% achieving optimal anticoagulation control (TTR≥65%). Under the expanded target range, the mean e-TTR was 38.3 ± 34.5%, with 29% achieving optimal control. In conclusion, outpatient VKA management remains suboptimal, warranting systematic optimization through the standardization of prescribing and monitoring protocols, alongside piloting specialized anticoagulation clinics integrated with information technology.
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References
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