Purpose: The Primary Antiphosholipid Syndrome (APS) is an autoimmune disease, characterized by the increased risk of thromboembolic events. There is no curative therapy for APS and the use of oral anticoagulants is necessary for disease control. Warfarin is the most commonly used oral anticoagulants; however due to its narrow therapeutic range and its high frequency of interactions with other drugs and foods, international normalized ratio (INR) control should be performed frequently. The aim of this study was to evaluate the use of warfarin and its effects on quality of life and treatment adherence in patients with APS and relate these data with the INR.
Methods: This is as prospective, clinical and observational study at the tertiary “Hospital de Clínicas” at UNICAMP, in Brazil. Patients diagnosed with Primary Antiphosholipid Syndrome were attended through pharmaceutical anamnesis to evaluate the quality of life, using Duke Anticoagulant Satisfaction Scale (DASS). This instrument is divided in three domains: limitations, psychological impacts and overload/tasks and the score of these summed domains, based on patient’s answers, can vary between 25-175 points considering that the higher the score, the greater the impact at patient’s life. Treatment adherence was evaluated by Treatment Measure Adhesion (TMA) – oral anticoagulants version; and treatment knowledge evaluated by MedTake test. The INR in the day of the interview was determined by the instrument CoaguXS-check.
Results: Thirty patients with Primary Antiphosholipid Syndrome were evaluated. According to MedTake test, 99.93% of patients knew the correct indication of warfarin, 100% knew the correct intake and drug regimen and 99.83% knew the correct dose of the drug. The treatment adherence is evaluated by the dichotomic instrument TMA in which 100% of patients were considered adherents. Based in the INR, 43.3% (INR mean 2.6 ± 1.1) of patients was out of anticoagulation target (between 2-3). The data of quality of life is represented in table 1 and the most affect domain in “patients with altered INR” and in “patients with INR in the target” is “limitations” domain, following by the “psychological impacts” domain and finally by the “overload/tasks” domain.
Conclusion: Although the patients presented a high adherence to the treatment, the therapeutic target of INR was not reached in many cases, which can lead to complications such as new thromboembolic events or bleeding. Once the treatment is chronic, the patients may end up neglecting. There isn’t statistical difference between the patient’s quality of life although INR target.
Julia Quintanilha– PhD student, State University of Campinas
Maria Cursino– PhD Student, University of Campinas, Campinas
Pedro Vasconcelos– State University of Campinas
Nadine Torso– State University of Campinas
Larissa Bastos– State University of Campinas
Juliana Oliveira– State University of Campinas
Mariana Medeiros– UNICAMP
Joyce Annichino-Bizzacchi– UNICAMP
Fernanda Orsi– UNICAMP
Patricia Moriel– UNICAMP