Skip to main content
SpringerLink
Log in

Adherence in outpatients taking warfarin and its effect on anticoagulation control in Jordan

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background Medication adherence is an important element for the success of any therapeutic plan. The picture is more complicated with warfarin, due to its small therapeutic window and patients’ needs to have effective anticoagulation control. Objective To measure warfarin-adherence, warfarin-knowledge and to assess the relationship between adherence and anticoagulation control. Setting Adult outpatients (≥18 years) taking warfarin at two medical sites in north of Jordan were invited to participate. Method This was a cross sectional study in which survey questionnaire that included demographic, clinical, warfarin related questions and Morisky Medication Adherence Scale (MMAS-8) was administered to patients in Arabic language. International normalization ratio (INR) readings were retrieved from patients’ medical records. Main outcome measure MMAS-8 adherence scores and time within therapeutic range were calculated. Results More than half of study participants (54 %) were adherent (MMAS-8 = 8). The MMAS-8 adherence scores were significantly associated with warfarin-knowledge scores (Spearman’s ρ = 0.291, p = 0.000). Adherent patients were more likely to have good anticoagulation control compared to non-adherent patients (MMAS-8 ≤ 7). Conclusion Adherence to warfarin therapy can have a substantial effect on anticoagulation control. Thus, healthcare practitioners should consider strategies to improve patient adherence to warfarin.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Use of the ©MMAS is protected by US copyright laws. Permission for use is required. A license agreement is available from: Donald E. Morisky, ScD, ScM, MSPH, Professor, Department of Community Health Sciences, UCLA School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772, dmorisky@ucla.edu

Similar content being viewed by others

References

  1. Kneeland PP, Fang MC. Current issues in patient adherence and persistence: focus on anticoagulants for the treatment and prevention of Thromboembolism. Patient Prefer Adherence. 2010;4:51–60.

    PubMed  PubMed Central  Google Scholar 

  2. Horstkotte D, Piper C, Wiemer M. Optimal Frequency of Patient Monitoring and Intensity of Oral Anticoagulation Therapy in Valvular Heart Disease. J Thromb Thrombolysis. 1998;5(Suppl 1(3)):19–24.

    Article  PubMed  Google Scholar 

  3. Gitter MJ, Jaeger TM, Petterson TM, Gersh BJ, Silverstein MD. Bleeding and thromboembolism during anticoagulant therapy: a population-based study in Rochester, Minnesota. Mayo Clin Proc. 1995;70:725–33.

    Article  CAS  PubMed  Google Scholar 

  4. Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med. 1998;158:1641–7.

    Article  CAS  PubMed  Google Scholar 

  5. Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest. 2008;133(6 suppl):160S–98S.

    Article  CAS  PubMed  Google Scholar 

  6. Platt AB, Localio AR, Brensinger CM, Cruess DG, Christie JD, Gross R, et al. Risk factors for nonadherence to warfarin: results from the IN-RANGE study. Pharmacoepidemiol Drug Saf. 2008;17:853–60.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kimmel SE, Chen Z, Price M, Parker CS, Metlay JP, Christie JD, et al. The influence of patient adherence on anticoagulation control with warfarin: results from the International Normalized Ratio Adherence and Genetics (IN-RANGE) Study. Arch Intern Med. 2007;167(3):229–35.

    Article  CAS  PubMed  Google Scholar 

  8. Couris R, Tataronis G, McCloskey W, Oertel L, Dallal G, Dwyer J, et al. Dietary vitamin K variability affects International Normalized Ratio (INR) coagulation indices. Int J Vitam Nutr Res. 2006;76(2):65–74.

    Article  CAS  PubMed  Google Scholar 

  9. Carlquist J, Horne B, Mower C, Park J, Huntinghouse J, McKinney J, Muhlestein J, et al. An evaluation of nine genetic variants related to metabolism and mechanism of action of warfarin as applied to stable dose prediction. J Thromb Thrombolysis. 2010;30:358–64.

    Article  CAS  PubMed  Google Scholar 

  10. Davis NJ, Billett HH, Cohen HW, Arnsten JH. Impact of adherence, knowledge, and quality of life on anticoagulation control. Ann Pharmacother. 2005;39(4):632–6.

    Article  PubMed  Google Scholar 

  11. Kim JH, Kim GS, Kim EJ, Park S, Chung N, Chu SH. Factors affecting medication adherence and anticoagulation control in Korean patients taking warfarin. J Cardiovasc Nurs. 2011;26:466–74.

    Article  PubMed  Google Scholar 

  12. Morisky DE, Ang A, Krousel-Wood M, Ward H. Predictive validity of a medication adherence measure for hypertension control. J Clin Hypertens. 2008;10(5):348–54.

    Article  Google Scholar 

  13. Krousel-Wood MA, Islam T, Webber LS, Re RS, Morisky DE, Muntner P. New Medication Adherence Scale Versus Pharmacy Fill Rates in Seniors With Hypertension. Am J Manag Care. 2009;15(1):59–66.

    PubMed  PubMed Central  Google Scholar 

  14. Morisky DE, DiMatteo MR. Improving the measurement of self-reported medication nonadherence: final response. J Clin Epidemiol. 2011;64:258–63.

    Article  Google Scholar 

  15. Wang Y, Kong MC, Ko Y. Psychometric properties of the 8-item Morisky Medication Adherence Scale in patients taking warfarin. Thromb Haemost. 2012;108(4):789–95.

    Article  CAS  PubMed  Google Scholar 

  16. Oliveira-Filho AD, Barreto-Filho JA, Neves SJ, Lyra Junior DP. Association between the 8-item Morisky Medication Adherence Scale (MMAS-8) and blood pressure control. Arq Bras Cardiol. 2012;99:649–58.

    Article  PubMed  Google Scholar 

  17. Wang Y, Kong MC, Ko Y. Comparison of three medication adherence measures in patients taking warfarin. J Thromb Thrombolysis. 2013;36:416–21.

    Article  CAS  PubMed  Google Scholar 

  18. Orensky IA, Holdford DA. Predictors of noncompliance with warfarin therapy in an outpatient anticoagulation clinic. Pharmacotherapy. 2005;25:1801–8.

    Article  CAS  PubMed  Google Scholar 

  19. Wang Y, Kong MC, Lee LH, Ng HJ, Ko Y. Knowledge, satisfaction, and concerns regarding warfarin therapy and their association with warfarin adherence and anticoagulation control. Thromb Res. 2014;133:550–4.

    Article  CAS  PubMed  Google Scholar 

  20. Rasmussen MA, Skov J, Bladbjerg EM, Sidelmann JJ, Vamosi M, Jespersen J. Multivariate analysis of the relation between diet and warfarin dose. Eur J Clin Pharmacol. 2012;68:321–8.

    Article  CAS  PubMed  Google Scholar 

  21. Hylek EM, Go AS, Chang Y, Jensvold NG, Henault LE, Selby JV, Singer DE. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med. 2003;349:1019–26.

    Article  CAS  PubMed  Google Scholar 

  22. Merli GJ, Tzanis G. Warfarin: what are the clinical implications of an out-of-range-therapeutic international normalized ratio? J Thromb Thrombolysis. 2008;27:293–9.

    Article  PubMed  Google Scholar 

  23. Ewen S, Retting-Ewen V, Mahfoud F, Bohm M, Laufs U. Drug adherence in patients taking oral anticoagulation therapy. Clin Res Cardiol. 2014;103:173–82.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to acknowledge Professor Donald E. Morisky for providing us with the 8-item Morisky Medication Adherence Scale.

Funding

This study was supported by the Ministry of Higher Education and Scientific Research, Amman, Jordan (Grant number 104/2012).

Author information

Authors and Affiliations

  1. Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan

    Mera A. Ababneh, Sayer I. Al-Azzam, Karem H. Alzoubi & Abeer M. Rababa’h

Authors
  1. Mera A. Ababneh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sayer I. Al-Azzam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karem H. Alzoubi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abeer M. Rababa’h
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mera A. Ababneh.

Ethics declarations

Conflicts of interest

There is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ababneh, M.A., Al-Azzam, S.I., Alzoubi, K.H. et al. Adherence in outpatients taking warfarin and its effect on anticoagulation control in Jordan. Int J Clin Pharm 38, 816–821 (2016). https://doi.org/10.1007/s11096-016-0282-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-016-0282-9

Keywords

Search

Navigation