Quality and Superiority of Anticoagulation therapy in neurological patients in a tertiary care hospital

ABSTRACT

Background: Oral anticoagulation (OAC) is used in neurology practice for primary and secondary stroke prevention in atrial fibrillation (AF). Since, there are lacunae of literature on the quality of anticoagulation in neurological patients this study was planned. Objective: To Evaluate the quality of oral anticoagulation therapy in neurology patients. Materials and methods: A prospective study was conducted on patients attending tertiary care neurology OPD who were prescribed oral anticoagulant (OAC). Consecutive sampling technique was used. Their international normalized ratio (INR) values were prospectively observed and the earlier INR values of the patients who were already on OAC were retrospectively scrutinized. The level of anticoagulation, factors intrusive with OAC and complications were noted. Results: The results were based on 70 patients with median age 45 year. Fifty patients received OAC for secondary stroke prevention, 16 for cerebral venous sinus thrombosis (CVST) and four for deep vein thrombosis (DVT). Of the 1280 INR reports, 500 (39.5%) reports were in the therapeutic range, 496 (38.5%) were below and 280 (21.9%) were above the therapeutic level. Stable INR was obtained in 30 (42.86%) patients only. The overall complication rate was 16.4 per 100 person-years. Conclusions: In the present study, it was concluded that stable therapeutic INR is tough to maintain in neurological patients. Optimal modification of diet, drug and dose of oral anticoagulant may support in stabilization of INR.