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Long-Term Statin Administration Does Not Affect Warfarin Time in Therapeutic Range in Australia or Singapore

1
Quality Use of Medicines Network, and Menzies Health Institute, School of Pharmacy & Pharmacology, Griffith University, Nathan, QLD 4215, Australia
2
Cardiology Department, National Heart Centre, Singapore 169609, Singapore
3
Pharmacy Department, National Heart Centre, Singapore 169609, Singapore
4
Royal College of Pathologists of Australasia Quality Assurance Programs, St Leonards, NSW 2065, Australia
5
Department of Emergency Medicine Gold Coast Hospital and Health Service, Griffith University, Nathan, QLD 4215, Australia
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2018, 7(5), 97; https://doi.org/10.3390/jcm7050097
Received: 19 April 2018 / Revised: 24 April 2018 / Accepted: 26 April 2018 / Published: 1 May 2018
(This article belongs to the Section Epidemiology & Public Health)
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PDF [239 KB, uploaded 3 May 2018]

Abstract

Background: Warfarin requires ongoing monitoring of the International Normalised Ratio (INR). This is because numerous factors influence the response, including drug interactions with commonly-prescribed medications, such as statins. The administration of statins with warfarin may change INR; however, there is limited information regarding the effects on warfarin control as measured by time in therapeutic range (TTR). Statins may also alter bleeds with warfarin, but there are conflicting reports demonstrating both increased and decreased bleeds, and limited data on diverse ethnic populations. Therefore, the aim of this study was to determine the effect of statin administration on warfarin control and bleeds in patients in Australia and Singapore. Methods: Retrospective data were collected for patients on warfarin between January and June 2014 in Australia and Singapore. Patient data were used to calculate TTR and bleed events. Concurrent statin therapy was assessed and comparisons of TTR and bleed incidence were made across patient subgroups. Results: Warfarin control in Australia and Singapore was not significantly affected by statins, as measured by TTR (83% and 58%, respectively), frequency of testing, and warfarin doses. In Australia, statin use did not significantly affect bleeds, whilst in Singapore the bleed incidence was significantly lower for patients on statins. Conclusions: Chronic concurrent administration of statins with warfarin does not adversely affect warfarin TTR in Australia or Singapore. In Singapore, patients on statins, compared to no statins, had a lower bleed incidence and this requires further investigation, especially given the potential genetic influences of ethnicity on both statin and warfarin metabolism. View Full-Text
Keywords: warfarin: statins; HMG-CoA reductase inhibitors warfarin: statins; HMG-CoA reductase inhibitors
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Bernaitis, N.; Ching, C.K.; Teo, S.C.; Badrick, T.; Davey, A.K.; Crilly, J.; Anoopkumar-Dukie, S. Long-Term Statin Administration Does Not Affect Warfarin Time in Therapeutic Range in Australia or Singapore. J. Clin. Med. 2018, 7, 97.

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