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Abstract

FACTORS INVOLVED IN THE IMBALANCE OF VITAMIN K ANTAGONISTS: EVALUATION OF PATIENTS' KNOWLEDGE AND PRACTICES

Iskandar Soumaya*, El-Hajj Maya*, Bou Zeid Mayssam, Zein Salam, Awada Sanaa, Rachidi Samar and Al-Hajje Amal

ABSTRACT

Background and purpose: Vitamin K antagonists (VKA) are considered to be one of the top five medications that are directly related to drug errors and to be one of the most common causes of emergency visits. This study aims to assess patients’ knowledge and practices to VKA treatment and to determine the factors related to VKA imbalanced treatment. Methods: A hospital-based case-control study was conducted in Beirut between September 1rst 2016 and June 30th 2017. Data were collected through a standardized questionnaire. Bivariate and multivariate analyses were done. Results: Patients with an INR within the therapeutic range were older (p<0.001) and had a lower educational level (p<0.001). They were also less knowledgeable about the name of the VKA medication (p<0.001), the dose (p<0.001), the indication (p<0.001), the action mechanism (p<0.001), the risk of over- and under-dose (p<0.001), the biological monitoring test (p<0.001), and the events accompanying taking aspirin along with VKA treatment (p=0.008). They were significantly more likely to forget to take their VKA treatment (P=0.023), double the VKA dose in case of forgetfulness (p=0.037), never notify health professionals about the VKA treatment (p=0.006), not inform the dentist about the VKA treatment in case of tooth extraction (p<0.001), and to not measure INR in case of blue spots (bruises) appearance (p=0.039) than control patients. Logistic regression showed that patients having an increased knowledge in regard to the name of the VKA taken and to the risk of overdose and under-dose were 2 to 3 times more likely to have an INR within the therapeutic range (ORa=0.39, 95% CI [0.21–0.73], p=0.003; ORa=0.59, 95% CI [0.36–0.96], p=0.034; and ORa=0.4, 95% CI [0.24–0.68], p=0.001 respectively). Moreover, informing the dentist about the VKA treatment and taking the right precautions in case of tooth extraction significantly decrease the risk of having an INR outside the therapeutic range (ORa=0.02, 95% CI [0.001–0.81], p=0.039). Patient’s therapeutic education on physical activity that may influence the VKA treatment has a significant association with reducing the risk of having an INR outside the therapeutic range among patients aged less than 65 years (ORa=0.36, 95% CI [0.15–0.88], p=0.026) than among patients aged 65 years or older. However, reading the instructions of usage available on the VKA box significantly reduce the risk of having an INR outside the therapeutic range among patients 65 years old or older (ORa=0.45, 95% CI [0.22–0.91], p=0.025). Conclusion: Patient education, physicians’ involvement and anticoagulant monitoring are critical for a balanced VKA treatment. Every patient taking VKA treatment has to acquire certain level of knowledge in regards to his/her treatment and know how to adopt the ordinary dose in order to limit the iatrogenic risk related to this treatment.

Keywords: Vitamin K antagonists, Knowledge, Practices, Imbalance, International Normalised Ratio.


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