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Fixed Low Dose Warfarin As Alternative Therapy To Prevent Thromboembolic Event In Atrial Fibrillation at Remote Area

Author : K. S. P. Adnyana, D. Y. Hermanto, Irnizarifka
Upload Date : 19-04-2018

Background: Preventing thromboembolic event in atrial fibrillation become a dilemma since the dissemination of health facilities in Indonesia was unequal. Not every hospital has an adequate resources to do INR examination, especially at remote area in Indonesia. In addition to patient compliance when multidrug was introduced, fixed-low-dose warfarin (FLDW) strategy using Indonesian 2-mg tablet was valuable to be studied, in the view of ischemic stroke prevention, major bleeding event, and cost efficiency compared to standard therapy.

Method: Descriptive study was carried out to identify ischemic stroke and bleeding event of FLDW in AF. This study used consecutive sampling from December 2016 to December 2017. All patients with atrial fibrillation using fixed low dose warfarin (2 mg) were included in this study. Patient who already using DAPT before and not adherence to the therapy are not include in this study. FLDW was introduced randomly once INR could not be checked again due to resources limitation.

Result: There were 172 patient with atrial fibrillation and after adapting to exclusion criteria, 51 patients were eligible to this study with mean age 57.49 years old. From demographic point of view, 29 patients (56.9%) are men. There are 16 patients (31.4%) with valvular atrial fibrillation, 3 patients (5.9%) with secondary atrial fibrillation because of thyroid dysfunction, and 32 patients (62.7%) with non-valvular atrial fibrillation. Ischemic stroke occur in 1 patient (2.0%) with mean of CHA2DS2-VASc score is 2.8. While, 4 patients (7.8%) have bleeding event consist of 3 events (5.9%) of gastrointestinal bleeding and 1 event (1.9%) of hemoptysis. The mean of HAS-BLED score is 2.6.

Conclusion: Fixed low dose warfarin can be used as alternative therapy in preventing thromboembolic event in atrial fibrillation at remote area whose don’t have INR examination. Risk of bleeding should be assessed carefully since fixed low dose warfarin has a significant bleeding episode. Futher study with larger sample size and prospective method is needed to represent the population

KEYWORDS : Atrial Fibrillation, thromboembolic event, fixed low dose warfarin

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