Authors

Josep Mercader-Coma, Núria Puig-Girbau, Mireia Mañas-Peña, Cristina Dorado-Sabaté, Tomás Escolano-Hernández, Mª José Parejo-Martín

Position

Enfermero/a. CAP Bordeta-Magòria. Institut Català de la Salut (ICS). Barcelona.

Abstract

Purpose: to assess the control level in patients receiving vitamin K antagonists (VKAs) in Primary Care, and to recognize risk factors associated to a poor control, the level of knowledge on INR and the use of nursing diagnoses and associates procedures.
Methods: an observational retrospective/cross-sectional study in a urban health center serving a population of 30,804 residents. Inclusion criteria: patients taking VKAs in February 2015. Endpoint: INR values; secondary endpoints: age, gender, and two closed questions on the knowledge on INR value and its impact.
Results: 541 patients; only those entirely controlled in Primary Care (296) were evaluated; mean age was 79±9 years (48.6% females). Overall, 3,080 measurements were performed, 81.8% in the clinic and 18.2% at home. INR was ≥ 60% within range in 69.3% of patients (last six months), 48% (last three measurements) and 32.4% (last two measurements). A high risk for bleeding was observed in 37.8% of patients. Overall, 50.2% of patients did not know whether their INR value was within range, and 50.4% could not explain the risk of being out of the range. Atrial fibrillation (AF) was present in 82.4% of patients and high blood pressure was found in 74.3%, among others.
Conclusions: well-controlled INR in our sample is more common than in previous literature. Half of participants did not know whether they had INR within range, their levels of risk, or its impact on their control. Based on IDC-10 classification and on NANDA “risk of bleeding”, the most common co-morbidity is atrial fibrillation; and the main procedure based on NIC are preventive measures to avoid bleeding.

Keywords:

Primary Care; oral anticoagulants; vitamin K antagonists; international normalized ratio control; awareness of international normalized ratio; NIC

Versión en Español

Título:

Grado de control de las personas en tratamiento oral con antagonistas de la vitamina K en Atención Primaria