Expert opinion on key aspects of managing education school for patients taking vitamin K antagonists

The leading problem in the use of vitamin K antagonist (VKA) therapy is the complexity and the need to maintain the international normalized ratio (INR) within therapeutic window of at least 60% of the treatment time. Obviously, the optimal solution to this problem in the context of modern technological capabilities is its self-monitoring by a patient and understanding the need to adjust the VKA (warfarin) dose to achieve the target INR values (independently or with the help of a physician’s consultation). Portable devices and a model of self-monitoring of anticoagulant therapy (coagulometers) has reduced the rates of thromboembolism, major bleeding, and all-cause mortality, and confirmed its high cost-effectiveness.

An important aspect for successful INR self-monitoring is comprehensive patient education, implemented within the specialized schools. Such educational programs provide patients with the necessary knowledge about warfarin, the importance of regular INR monitoring, the aspects of self-monitoring, possible complications and actions in emergency situations. The combination of structured training and subsequent INR self-monitoring contributes to a significant increase in therapy adherence and improved clinical outcomes. The results of systematic reviews and randomized trials confirm that patient participation in educational programs reduces the risk of thromboembolic and hemorrhagic events and increases the overall effectiveness of treatment. The aim of the work was to formulate the key aspects of managing an education school for patients taking VKA.

The combination of educational programs, active follow-up, coagulometers, and remote monitoring forms a holistic model for managing patients receiving VKA that meets modern requirements for clinical efficacy, safety, and cost-effectiveness.

1. Bokeria LA, Milievskaya EB, Prianishnikov VV, Yurlov IA. Cardiovascular surgery — 2022. Diseases and congenital anomalies of the circulatory system. M.: A.N. Bakulev National Medical Research Center of Cardiovascular Surgery, Ministry of Health of the Russian Federation. 2023, р. 344. (In Russ.) ISBN: 978-5-7982-0451-9.

2. Chruslov MV, Kasianov IO. Universal method for assessing of economic losses from complications in patients taking indirect anticoagulants for atrial fibrillation, depending on the time spent in the therapeutic range of INR. Thrombosis, hemostasis and rheology. 2017;(1):12-20. (In Russ.)

3. Kamthornthanakarn I, Krittayaphong R. Optimal INR level for warfarin therapy after mechanical mitral valve replacement. BMC Cardiovasc Disord. 2019;19(1):97. doi:10.1186/s12872-019-1078-3.

4. Geng L, Gu J, Li M, et al. Frequency of prothrombin time-international normalized ratio monitoring and the long-term prognosis in patients with mechanical valve replacement. BMC Cardiovasc Disord. 2023;23(1):322. doi:10.1186/s12872-023-03293w.

5. Gorbunova EV, Rozhnev VV, Lyapina IN, Barbarash OL. Dynamics of adherence to treatment and quality of life in patients with prosthetic heart valves who participated in the educational programs (10 year follow-up). Complex Issues of Cardiovascular Diseases. 2022;11(1):69-77. (In Russ.) doi:10.17802/2306-1278-2022-11-1-69-77.

6. Tkacheva ON, Vorobyeva NM, Kotovskaya YuV, et al. Antithrombotic therapy in the elderly and senile age: the consensus opinion of experts of the Russian Association of Gerontologists and Geriatricians and the National Society of Preventive Cardiology. Cardiovascular Therapy and Prevention. 2021;20(3):2847. (In Russ.) doi:10.15829/17288800-2021-2847.

7. Vialkova AI, Oganov RG. Health promotion and disease prevention. Basic terms and concepts. M., GEOTAR-Media, 2000. p. 21. (In Russ).

8. Martsevich SY, Lukina YV. Warfarin and its Importance in the Era of New Oral Anticoagulants. Issues of Monitoring the Effectiveness and Safety of Treatment. Rational Pharmacotherapy in Cardiology. 2017;13(5):699-705. (In Russ.) doi:10.20996/1819-6446-2017-13-5-699-705.

9. Irtyuga OB, Shmakov RG, Vavilova TV, et al. Debating points of anticoagulation in the prevention of venous thromboembolism in pregnant women with cardiovascular and systemic diseases. Expert council resolution. Russian Journal of Cardiology. 2023;28(4):5421. (In Russ.) doi:10.15829/1560-4071-2023-5421.

10. Steffel J, Collins R, Antz M, et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-¬Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021;23(10):1612-76. doi:10.1093/europace/euab065.

11. Turen S, Turen S. Determination of Factors Affecting Time in Therapeutic Range in Patients on Warfarin Therapy. Biol Res Nurs. 2023;25(1):170-8. doi:10.1177/10998004221127977.

12. Vorob’eva NA, Vorob’eva AI, Shapkov AA. Gemorragic complications in antithrombotic therapy in real clinical practice. Therapy. 2022;(4):15-22. (In Russ.) doi:10.18565/therapy.2022.4.15-22.

13. Vavilova TV, Solovyova LV, Bekoeva AB, et al. The best practices of the Russian Federation in the organization of anticoagulant therapy in patients with high risk of thromboembolic events. Russian Journal of Cardiology. 2020;25(6):3945. (In Russ.) doi:10.15829/1560-4071-2020-3945.

14. Tan CSS, Lee SWH. Warfarin and food, herbal or dietary supplement interactions: A systematic review. Br J Clin Pharmacol. 2021;87(2):352-74. doi:10.1111/bcp.14404.