Compliance, frequency of target INR achievement and complications in patients on long term oral anticoagulant therapy

To assess compliance and achievement of target international normalized ratio [INR] in patients with a broad range of indications for long term oral anticoagulant therapy [OAT] with warfarin. Case-review of 50 patients on long term OAT. Department of Cardiology, Shifa International Hospital, July 2004-Dec 2004. Medical records of 50 patients on long term OAT for at least six months and being followed in the cardiology outpatient department [OPD] were reviewed. Data was collected and analyzed for indication for OAT, frequency of INR check, target INR achievement and subsequent complications. Descriptive statistics were used to detect frequencies. Out of a total of 50 patients, 30 [60%] were male and 20 [40%] were female. Majority of the patients [61%] belonged to the cities of Islamabad and Rawalpindi. 40.9% of the patients were getting their INR checked every 1-2 months. 20.5% were getting it checked every 2-4 months and a third [38.6%] was having their INR checked more than 4 months apart. Commonest indications for OAT were atrial fibrillation alone [25%], prosthetic heart valve alone [29.5%] or both [20%]. Average INR values were between 1-2 in 17 [38.6%], between 2-3 in 22 [50%] and more than 3 in 5 [11.4%] patients. Major complications occurred in 2 [4.6%] patients only. Majority of the patients on long term OAT were getting their INR checked latter than recommended with a third of the patients with INR checks more than 4 months apart. More than a third of the patients did not achieve their target INR. However, despite these suboptimal results, major complications occurred very infrequently

Role of inferior vena cava filter implantation in preventing pulmonary embolism

A retrospective review of all patients undergoing IVC filter implantation at Shifa International Hospital, Islamabad, from June 2004 to June 2006 was conducted to study the indications of inferior vena cava [IVC] filter use and impact on short-term morbidity/mortality. A total of 17 patients received IVC filters. Five patients were excluded due to data loss. One month clinical follow-up was available for 12 patients and 6 months follow-up was also available for 4 of 12 patients. The underlying disease was deep venous thrombosis [DVT] with pulmonary embolism [PE] in 6 [50%], DVT without PE in 4 [33.3%] and PE with negative duplex scan for DVT in 2 [16.6%] patients, respectively. Indications for IVC filter implantation were DVT and/or PE with contraindication to anticoagulation in 8 [66.7%] and DVT and/or PE with complications of anticoagulation in 4 [33.3%] patients. No procedure-related complications were noted in all 17 patients. Three patients [25%] died of non-PE related causes during the 1st month. There were no PE related mortalities at 6 months. This data set indicates that IVC filter implantation is a safe procedure with no short-term morbidity/mortality and potential long-term mortality benefit