The Prevalence of Sub Optimal Anti Coagulation

NCT ID: NCT03485300

Last Updated: 2018-07-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

50 participants

Study Classification

OBSERVATIONAL

Study Start Date

2018-12-31

Study Completion Date

2019-12-31

Brief Summary

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A study on warfarin administration to show whether noncompliance of the patient will affect our target (INR) during therapy or not beside its drug and dietary interactions.

The study will show the prevalence of sub optimal anti coagulation among patients with prosthetic cardiac valves that will undergo warfarin therapy.

Detailed Description

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Besides the risk of infective endocarditis, thromboembolism from the foreign body structures of the prosthesis remains a major problem, which can be effectively reduced, but not inhibited by the use of oral anticoagulants in patients with prosthetic cardiac valves.

Warfarin as a vitamin k antagonist is widely used to decrease risk of thromboembolism but need strict monitoring for INR to avoid warfarin failure or hemorrhage.

It acts through inhibiting an enzyme called the vitamin K1 2,3 epoxide reductase complex, subunit1 (VKORC1).

All patients with mechanical heart valves need the oral anticoagulation to keep the INR between 2.5:3.5 according to valve type, position and other comorbid conditions.

However some patients need higher than expected doses of warfarin to get their (INR) into the target therapeutic range.

Resistance to warfarin has been described as the inability to prolong the prothrombin time or raise the international normalized ratio (INR) into the therapeutic range when the drug is given at normally prescribed doses.

Resistance is different than warfarin failure ,which is defined as a new thrombotic event despite a therapeutic prothrombin time and INR .

The causes of warfarin resistance can be either acquired from high consumption of vitamin K or C ,decreased absorption or increased clearance of the drug ,dietary or drug interactions or hereditary by genetic factors that result either in faster metabolism of the drug (a form of pharmacokinetic resistance) or in lower activity of the drug (pharmacodynamic resistance).

Conditions

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Poor Drug Response

Study Design

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Observational Model Type

COHORT

Study Time Perspective

CROSS_SECTIONAL

Study Groups

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Patients with chronic liver or kidney diseases

Patients with chronic liver diseases may affect warfarin therapeutic outcome as liver is the site of metabolism of the drug by cytochrome p 450 enzymes so it decrease warfarin absorption

Kidney diseases also affect the clearance of the drug these patients will undergo liver function tests and kidney function tests

Liver and kidney function tests for patients with chronic liver or kidney diseases

Intervention Type DIAGNOSTIC_TEST

Tests will be done to patients with history suggestive of chronic liver or renal diseases or for patients clinically suspected

Non compliance of the patient

Missed dose of the warfarin or intermittent drug intake may affect drug therapeutic outcome as well as changing time of drug administration during the day

Non compliance of the patient

Intervention Type BEHAVIORAL

I will order all my patients to take the drug at 10 am and assure the daily in taking of the dose and they will be followed up

Drugs or food interactions

Administration of other drugs beside warfarin may affect its therapeutic outcome either by inhibition or synergism certain food may also interfere with warfarin especially vitamin k and c rich food so patients will be followed up for drug or food interactions

Drug or food interactions

Intervention Type DRUG

The patient will be in contact with the researcher for any drug added with warfarin in case of other co morbidity conditions and follow up his/her CBC and INR for measuring its effect on warfarin finding out the effect of food on warfarin therapeutic outcome

Interventions

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Liver and kidney function tests for patients with chronic liver or kidney diseases

Tests will be done to patients with history suggestive of chronic liver or renal diseases or for patients clinically suspected

Intervention Type DIAGNOSTIC_TEST

Non compliance of the patient

I will order all my patients to take the drug at 10 am and assure the daily in taking of the dose and they will be followed up

Intervention Type BEHAVIORAL

Drug or food interactions

The patient will be in contact with the researcher for any drug added with warfarin in case of other co morbidity conditions and follow up his/her CBC and INR for measuring its effect on warfarin finding out the effect of food on warfarin therapeutic outcome

Intervention Type DRUG

Other Intervention Names

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SGOT - SGPT - albumin creatinine - urea Asking patient about daily intake of the drug in certain time Checking other drugs may be added with warfarin and dietary habits

Eligibility Criteria

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Inclusion Criteria

All patients of prosthetic cardiac valves undergo warfarin therapy with sub optimal anti coagulation

Exclusion Criteria

* Refusal of the patients
* Patients with target INR (2.5-3.5)
* Patients with hypoalbumenimia and chronic liver diseases
Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Assiut University

OTHER

Sponsor Role lead

Responsible Party

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Mariam Sobhy Gerges

Resident hematologist at internal medicine department

Responsibility Role PRINCIPAL_INVESTIGATOR

Central Contacts

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Ahmed Ali Obiedallah an assistant professor at internal medicine department, MD

Role: CONTACT

01007556396

Related Links

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http://www.ncbi.nlm.nih.gov/pubmed/28680174

Management of Supratherapeutic International Normalized Ratio without Bleeding after Warfarin Use

Other Identifiers

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Sub optimal anti coagulation

Identifier Type: -

Identifier Source: org_study_id

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