The impact of the COVID-19 pandemic on the management of patients under vitamin K antagonists

Abstract

ABSTRACT:
Introduction: Since the first case detected, all the attention of the medical community has focused on the management of patients with COVID-19. This pandemic has indeed influenced our healthcare system aiming at a minimum of contact between patients and healthcare professionals.
We therefore considered it’s important to evaluate the outcome and the management of patients under vitamin K antagonists (VKA) during the first lockdown period of the COVID 19 pandemic.
Methods: This is a retrospective, single-center descriptive study including 100 patients on VKA. The data was collected from the files and interviews of patients hospitalized at the Ariana cardiology department or ambulatory outpatient or contacted by telephone during the month of August 2020.
Results: The population was predominantly female (55%) with an average age of 61.59 years. 58% of patients did not know their target international normalized ratio (INR). During lockdown period, 49% of patients had an INR check. 71.7% of blood samples were taken in a private laboratory and 27.3% in another nearby public structure. To adjust their treatment, 20% of patients called their treating physicians, 31% saw another physician and 49% adjusted the doses on their own. After reopening, 54% of patients did not visit the hospital for one month. At the time of the first medical contact, 57% of the INRs were in the therapeutic zone. There is a significant relationship between therapeutic education and the regularity of the INR control in lockdown (p = 0.01) and between the regularity of the INR control and an INR after lockdown in a therapeutic zone (p = 0.000).
Conclusion: The COVID-19 pandemic has negatively impacted the quality of care of patients on VKA, particularly in the absence of therapeutic education. The management of these patients during this pandemic had to be adjusted.