[01] Mohammed Khalid Hussien, Nursing Department, Alghad Colleges for Applied Medical Sciences, Najran, Kingdom of Saudi Arabia. [02] Adam Ahmed Adam, Microbiology Department, Faculty of Medicine, Alneelain University, Khartoum, Sudan.

Background: Warfarin therapy poses a great challenge for the patient and the physician in striking a balance between bleeding and thrombosis when long term anticoagulation is decided. This drug has a narrow therapeutic range and bleeding or coagulation is an easily reached complication. Shared knowledge between the patient and the managing medical team can tip the balance towards a better control. Commonly the patient may not have the necessary information. This knowledge gap can be bridged by educating the patient through a well-structured educational programme. Objective. This study aimed to assess the impact of a structured educational programme on the knowledge of patients with replaced heart valves on long term warfarin anticoagulation therapy. Methods. The study was conducted in Ahmed Gasim Cardiac Centre in Khartoum North in Sudan. The participants were patients with replaced heart valves on warfarin anticoagulation therapy. The total number of patients attending the hospital during the study duration was 600 patients. The sample size enrolled in the study was 125 patients. The sampling method used was the non-probability convenience sampling. The participants’ knowledge about different aspects of warfarin as an anticoagulant was assessed before and after implementation of a structured education programme about warfarin anticoagulation therapy. Results. The participants’ knowledge about the indication of warfarin therapy, the drugs and diseases that affect warfarin action and compliance with the drug prescription improved significantly after implementation of the educational programme. Moreover, their knowledge about the normal results of INR, frequency of its routine measurement and signs of its abnormal results improved significantly. Conclusion. The educational programme had a statistically significant positive impact on the participants’ knowledge about warfarin coagulation therapy. Construction and implementation of relevant educational programmes can improve the managing strategy and its outcome.

Warfarin, Educational Programme, Ahmed Gasim

[01] Munir, P., Warfarin: almost 60 years old and still causing problems, Br J Clin Pharmacol. 2006 Nov; 62(5): 509–511. [02] Boonyawat K., Caron F., Li A., Chai-Adisaksopha C., Lim W., Iorio A., Lopes R. D., Garcia D., Crowther M. A., Association of body weight with efficacy and safety outcomes in phase III randomized controlled trials of direct oral anticoagulants: a systematic review and meta-analysis, J Thromb Haemost. 2017 Apr 13 (pubmed). [03] Karazivan P., Dumez V., Flora L., Pomey M. P., Del Grande C., Ghadiri D. P., Fernandez N., Jouet E., Las Vergnas O., Lebel P., The patient-as-partner approach in health care: a conceptual framework for a necessary transition, Acad Med. 2015 Apr;90(4):437-41 (pubmed). [04] Breslow L., Patient education in historical perspective, Bull N Y Acad Med. 1985 Mar; 61(2): 115–122. [05] Ching T. B., Sulaiman S. S., Suleiman A. K., Gillani S. W., Abubakar U., Knowledge of warfarin therapy among patients attending Warfarin Clinic at a Public Hospital in Northern part of Malaysian Peninsular. Arch Pharma Pract 2016;7: 7 -14. [06] Baillargeon J., Holmes J., Lin Y., Raji M., Sharma G., and Kuo Y., Concurrent Use of Warfarin and Antibiotics and the Risk of Bleeding in Older Adults, Am J Med. Author manuscript; available in PMC 2013 Jul 16. Published in final edited form as: Am J Med. 2012 Feb; 125(2): 183–189. [07] Hunter C., and Phan S., Warfarin and phenytoin drug interaction with possible purple glove syndrome, J Pharmacol Pharmacother. 2016 Apr-Jun; 7(2): 96–98. [08] [8]. Chandelia S., and Dubey N. K., Warfarin-induced raised international normalized ratio is further prolonged by pantoprazole, Indian J Crit Care Med. 2016 Feb; 20(2): 127–128. [09] Teklay G., Shiferaw N., Legesse B., and Bekele M. L., Drug-drug interactions and risk of bleeding among inpatients on warfarin therapy: a prospective observational study, Thromb J, 2014, 22:54. [10] Clark N., Delate T., Riggs C., Witt D., Hylek E., Garcia D., Ageno W., Dentali F., Crowther M., Warfarin Interactions with Antibiotics in the Ambulatory Care Setting, JAMA Intern Med. 2014;174(3):409-416. [11] Clarkesmith D., Pattison H., Lip G., Lane D., Educational Intervention Improves Anticoagulation Control in Atrial Fibrillation Patients: The TREAT Randomised Trial, PLoS, September 9, 2013. [12] Smith K., Aljazairi A., and Fuller S., INR Elevation Associated with Diarrhea in a Patient Receiving Warfarin, Annals of Pharmacotherapy33(3):301-4 • April1999 [13] Reaves AB, Clarke CJ, Tillman EM., Supratherapeutic international normalized ratio due to reduced vitamin K intake secondary to prolonged vomiting in a patient on warfarin, Ann Pharmacother. 2013 Jun;47(6):pubmed. [14] Tideman P., Tirimacco R., St John A., and Roberts G., How to manage warfarin therapy, Aust Prescr. 2015 Apr; 38(2): 44–48. [15] Collins S., Barber A., and Sahm L., Pharmacist’s Counselling Improves Patient Knowledge Regarding Warfarin, Irrespective of Health Literacy Level, Pharmacy 2014, 2, 114-123.