Increasing Availability of the International Normalized Ratio Control in Russia

ORIGINAL ARTICLE
Natalya V. Aksyutina, Fyodor G. Zograf, Vasily S. Mordovsky, Oksana A. Gavrilyuk, Pavel S. Marinushkin, Vladimir A. Shulman, Irina S. Knyazeva, Aleksandr M. Sitnikov, Mikhail I. Gavrilenko, Viktor V. Kusaev, Elena E. Aldanova

 
International Journal of Biomedicine. 2018;8(4):292-295.
DOI: 10.21103/Article8(4)_OA4
Originally published December 15, 2018

Abstract: 

Background:: Warfarin is still, in some cases, the only medication to prevent thromboembolic complications. Warfarin intake imposes regular INR monitoring, which can be performed domiciliary. Currently, in the Russian market, there are two models of automatic portable blood coagulometers: CoaguChek XS (Germany) and qLabs ElectroMeter (China). The main problem of portable coagulometers is their high cost and high cost of operation, which the majority of patients cannot afford. To explore the demand for development of a Russian coagulometer with a more affordable price, a questionnaire survey was carried out among the patients who needed this device.
Methods and Results: We surveyed 70 patients taking Warfarin, with 5 years duration paroxysmal, persistent/or stable AF of nonvalvular etiology, having >2 CHADS-VASc score for thrombembolia risk assessment and <3 HAS-BLED score for hemorrhage risk assessment. According to the survey results, 7 (10%) patients had portable coagulometers, including 3 persons with CoaguChek XS and 4 persons with Micropoint qLabs ElectroMeter. Among these patients, there were 4 persons who continued regular INR monitoring domiciliary, while 3 patients had financial difficulties in getting testing strips. At the same time, 14 (20%) patients were not aware of the possibility of domiciliary INR monitoring. As it turned out, those patients who received regular INR monitoring domiciliary with a portable coagulometer, or at their local polyclinics, had neither ischemic strokes nor hemorrhages within a period of five years.
Conclusion: It is critical to develop and manufacture a domestic equivalent of a portable coagulometer and testing strips for household use at a more affordable price.

Keywords: 
portable coagulometers • international normalized ratio • atrial fibrillation • Warfarin
References: 
  1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Rev Esp Cardiol (Engl Ed). 2017 Jan;70(1):50. doi: 10.1016/j.rec.2016.11.033. [Article in English, Spanish]. PubMed
  2. Bernaitis N, Badrick T, Davey AK, Crilly J, Anoopkumar-Dukie S. Warfarin control in patients transitioning to warfarin after non-vitamin K oral anticoagulant (NOAC) therapy. J Thromb Thrombolysis. 2018 Nov;46(4):461-465. doi: 10.1007/s11239-018-1719-x. PubMed
  3. Skaistis J, Tagami T. Risk of Fatal Bleeding in Episodes of Major Bleeding with New Oral Anticoagulants and Vitamin K Antagonists: A Systematic Review and Meta-Analysis. PLoS One. 2015 Sep 18;10(9):e0137444. doi: 10.1371/journal.pone.0137444. eCollection 2015. PubMed
  4. Bogachev VYu. Warfarin... Death is postponed. Regular Issues of the Russian Medical Journal. 2013;21(15):797-807.
  5. Keller C, Matzdorff AC, Kemkes-Matthes B. Pharmacology of warfarin and clinical implications. Semin Thromb Hemost. 1999;25(1):13-6. PubMed
  6. Yavelov IS. [Antagonists of Vitamin K in the prevention and treatment of thrombosis and thromboembolism: updated recommendations of the American College of Thoracic Doctors]. Atherothrombosis. 2009;1(2):55-76. [Article in Russian].
  7. Berkovsky АL, Sergeeva EV, Prostakova TM, Melkumyan АL, Suvorov А. Screening tests of plasma hemostasis, Prothrombin time, APTT, Thrombin time, Fibrinogen. Moscow; 2016.
  8. Titaeva EV, Dobrovolsky АB. Possible sources of errors in the determination of INRs and ways to solve them. Atherothrombosis. 2015;(2):107-114. [Article in Russian].
  9. WHO Expert Committee on Biological Standartization. Guidelines for Thromboplastins and Plasma Used to Control Oral Anticoagulant Therapy. Annex 3. World Health Organ Tech Rep Ser. 1999;889:64-93
  10. Brasen CL, Madsen JS, Parkner T, Brandslund I. Home Management of Warfarin Treatment Through a Real-Time Supervised Telemedicine Solution: A Randomized Controlled Trial. Telemed J E Health. 2018 Jun 7. doi: 10.1089/tmj.2017.0260. [Epub ahead of print]. PubMed
  11. Smaradottir B, Martinez S, Borycki E, Loudon G, Kushniruk A, Jortveit J, Fensli R. User Evaluation of a Smartphone Application for Anticoagulation Therapy. Stud Health Technol Inform. 2018;247:466-470. PubMed

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Received October 15, 2018.
Accepted November 23, 2018.
©2018 International Medical Research and Development Corporation.