The Suitability of INR (International Normalized Ratio) of Atrial Fibrillation Patients with Warfarin Therapy in Hospital “X” Jakarta January - December 2024
Abstract
Atrial fibrillation is a supraventricular arrhythmia with irregular atrial activation. One of the therapies that can be given is vitamin K antagonist class anticoagulants, namely warfarin. Bleeding often occurs in patients receiving warfarin therapy, so the use of anticoagulants must be balanced with an examination of the International Normalized Ratio. This study aims to evaluate the relationship between warfarin dose and the International Normalized Ratio value of atrial fibrillation patients at “X” hospital in Jakarta. The method used was a non-experimental analytic, cross-sectional design using medical record data. Data were processed using SPSS version 25 with the Spearman Rank method. The inclusion criteria used in this study were outpatients with a diagnosis of atrial fibrillation, aged 25 to ≥ 85 years, receiving warfarin therapy, and having complete laboratory examination results, including International Normalized Ratio values. The number of samples that met the inclusion criteria was 60 patients. The results showed that patients with warfarin therapy were more male patients, namely 31 patients (52%), the most age range was 55-64 years (38%), most International Normalized Ratio examinations were carried out 1-4 times a year (73%), and patients with an International Normalized Ratio value of 2-3 were 13 people (21%). Statistical tests showed no significant relationship between warfarin dose and International Normalized Ratio value, the p value obtained was 0.164, which means that there is no significant relationship between the difference in the use of warfarin doses in atrial fibrillation patients at “X” Hospital Jakarta, January - December 2024, to the suitability of INR values.References
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Chao, T. F., Joung, B., Takahashi, Y., Lim, T. W., Choi, E. K., Chan, Y. H., Guo, Y., Sriratanasathavorn, C., Oh, S., Okumura, K., & Lip, G. Y. H. (2021). 2021 Focused update of the 2017 consensus guidelines of the Asia Pacific Heart Rhythm Society (APHRS) on stroke prevention in atrial fibrillation. Journal of Arrhythmia, 37(6), 1389–1426. https://doi.org/10.1002/joa3.12652
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Lucà, F., & Parrini, I. (2025). The Elderly Patient with Atrial Fibrillation: Optimal Treatment Strategies. Journal of Clinical Medicine, 14(5), 10–14. https://doi.org/10.3390/jcm14051753
MIMS. (2019). MIMS Petunjuk Konsultasi (19th ed.). Bhuana IlmuPopuler
Musnelina, L., Handayani, F., Vo, T., & Pontoan, J. (2023). Trends in use of Direct Oral Anticoagulants and Warfarin in Atrial Fibrillation Patients. 21(2), 264–270.
Nicolas, D., Elmouhayyar, C., Nicolas, S., Talj, J., Hattar, L., & Alhudairy, M. (2020). Subtherapeutic INR due to warfarin interaction with smokeless tobacco. Journal of Thrombosis and Haemostasis, 18(11), 2954–2957. https://doi.org/10.1111/jth.15057
Ningrum, V. DA, Dyah Widyastuti, I., Sufriyanto Yusuf, B., & Dullah, W. (2020). Bleeding Incidence in Patients Administered with Warfarin at Secondary Hospitals in Yogyakarta Province. Indonesian Journal of Pharmacy, 31(3), 217–228.
Octasari, P. M., & Silvianingsih, N. (2022). Kesesuaian Nilai INR ( International Normalized Ratio ) Pasien Kardiovaskuler Dengan Terapi Warfarin Di Poli Spesialis Jantung RS Roemani Muhammaddiyah This study aims to determine the suitability of the INR value in cardiovascular patients with warfarin. Cendikia Journal of Pharmacy, 6(1), 46–54.
PERKI. (2019). Pedoman Tata Laksana Fibrilasi Atrium Non-Valvular (2nd ed.). PT. Trans Medical International.
Price, E. L., & Ansell, J. (2022). Virtual Education for Patient Self-Testing for Warfarin Therapy Is Effective During the COVID-19 Pandemic. The Joint Commission Journal on Quality and Patient Safety, 48(4), 214–221. https://doi.org/10.1016/j.jcjq.2022.01.001
Putri, N. A., Lestari, K., Diantini, A., & Rusdian, T. (2012). Monitoring Terapi Warfarin pada Pasien Pelayanan Jantung pada Rumah Sakit di Bandung. Jurnal Farmasi Klinik Indonesia, 1(3), 110–116.
Rahmatini, R., Aliska, G., Usman, E., Yanni, M., & Ilmiawati, C. (2020). Plasma warfarin level and international normalized ratio do not correlate with bleeding events in indonesian patients of minangkabau ethnicity with atrial fibrillation. Open Access Macedonian Journal of Medical Sciences, 8(B), 192–197. https://doi.org/10.3889/OAMJMS.2020.3436
Rodríguez-Vélez, R., Ortiz-Rivera, O. J., Bower, B., Gorowski, K., Windemuth, A., Villagra, D., Kocherla, M., Seip, R. L., D’Agostino, D., Vergara, C., Ruaño, G., & Duconge, J. (2010). Exposure to non-therapeutic INR in a high risk cardiovascular patient: Potential hazard reduction with genotype-guided warfarin (coumadin®) dosing. Puerto Rico Health Sciences Journal, 29(4), 402–408.
Scridon, A. (2022). Autonomic imbalance and atrial ectopic activity—a pathophysiological and clinical view. Frontiers in Physiology, 13(December), 1–16. https://doi.org/10.3389/fphys.2022.1058427
Sensuwaty, Widiastuti, H. P., & Firdaus, R. (2023). Kualitas Hidup Pasien Atrial Fibrilasi Post Rawat Inap Di RSD dr. H. Soemarno Sosroatmodjo Tanjung Selor. Aspiration of Health Journal, 01(02), 230–239. https://doi.org/https://doi.org/10.55681/aohj.v1i2.103
Shin, J., Andrews, M., DeJean, L., Debski, N., Exarchakis, A., Fleming, J., Gandhi, R., Hum, C., Kalladanthyil, A., Maddigunta, R., Napoli, L., Nguyen, C., Paul, R., Schmalbach, N., Sichel, J., Snyder, S., Stern, M., Thampi, S., Viggiano, J., … Roy, S. (2023). Risk Factors Associated With Atrial Fibrillation in Elderly Patients. Journal of Clinical Medicine Research, 15(3), 148–160. https://doi.org/10.14740/jocmr4884
Staerk, L., Sherer, J. A., Ko, D., Benjamin, E. J., & Helm, R. H. (2018). Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcome. Circ Res, 120(9), 1501–1517. https://doi.org/10.1161/CIRCRESAHA.117.309732
Tan, J. L., Johnson, L., Dziubinski, M., Napiorkowski, N., Witkowska, O., Slusarczyk, M. E., Healey, J. S., & Russo, A. M. (2022). Sex differences in presentation of atrial fibrillation: Findings from 30-day ambulatory monitoring in real-world practice. American Heart Journal Plus: Cardiology Research and Practice, 22(September), 100208. https://doi.org/10.1016/j.ahjo.2022.100208
Tana, M., Tana, C., Guglielmi, M. D., Stefanelli, A., Mantini, C., & Porreca, E. (2024). Current Perspectives on Atrial Amyloidosis: A Narrative Review. Reviews in Cardiovascular Medicine, 25(2). https://doi.org/10.31083/j.rcm2502073
Tang, Y., Chen, Q., Liang, B., Peng, B., Wang, M., Sun, J., Liu, Z., Zha, L., & Yu, Z. (2022). A retrospective cohort study on the association between early coagulation disorder and short-term all-cause mortality of critically ill patients with congestive heart failure. Frontiers in Cardiovascular Medicine, 9. https://doi.org/10.3389/fcvm.2022.999391
Tran, C., Yeap, B. B., Ball, J., Clayton-chubb, D., Hussain, M., Brodtmann, A., & Tonkin, A. M. (2024). Articles Testosterone and the risk of incident atrial fi brillation in older men : further analysis of the ASPREE study. EClinicalMedicine, 72, 1–9. https://doi.org/10.1016/j.eclinm.2024.102611
Triposkiadis, F., Pieske, B., Butler, J., Parissis, J., Giamouzis, G., Skoularigis, J., Brutsaert, D., & Boudoulas, H. (2016). Global left atrial failure in heart failure. European Journal of Heart Failure, 18(11), 1307–1320. https://doi.org/10.1002/ejhf.645
Untari, E. K., Rizkifani, S., Yuswar, M. A., & Robiyanto, R. (2023). Survey Pengetahuan, Sikap dan Persepsi Mahasiswa Kesehatan Mengenai Farmakogenomik. PHARMACY: Jurnal Farmasi Indonesia (Pharmaceutical Journal of Indonesia), 19(2), 184–193. https://doi.org/10.30595/pharmacy.v19i2.8985
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Cavallari, L. H., & Duarte, J. D. (2015). Genes affecting warfarin response - Interactive or additive? Journal of Clinical Pharmacology, 55(3), 258–260. https://doi.org/10.1002/jcph.425
Chandra, M. S., Kumala, S., & Keban, S. A. (2020). Evaluating the Use of Warfarin Using the HAS-BLED Score and INR on Atrial Fibrillation Patients at Harapan Kita National Heart Center. Jurnal Profesi Medika : Jurnal Kedokteran Dan Kesehatan, 14(2), 132–136. https://doi.org/10.33533/jpm.v14i2.1671
Chang, Y. T., Chen, Y. L., & Kang, H. Y. (2021). Revealing the influences of sex hormones and sex differences in atrial fibrillation and vascular cognitive impairment. International Journal of Molecular Sciences, 22(16). https://doi.org/10.3390/ijms22168776
Chao, T. F., Joung, B., Takahashi, Y., Lim, T. W., Choi, E. K., Chan, Y. H., Guo, Y., Sriratanasathavorn, C., Oh, S., Okumura, K., & Lip, G. Y. H. (2021). 2021 Focused update of the 2017 consensus guidelines of the Asia Pacific Heart Rhythm Society (APHRS) on stroke prevention in atrial fibrillation. Journal of Arrhythmia, 37(6), 1389–1426. https://doi.org/10.1002/joa3.12652
Cheng, S., He, J. Z., Han, Y., Han, S., Li, P., Liao, H., & Guo, J. (2024). Global burden of atrial fibrillation/atrial flutter and its attributable risk factors from 1990 to 2021. Europace, 26(7), 1–20. https://doi.org/10.1093/europace/euae195
Choi, D. H., Piao, Y. J., Choi, E. J., Choi, J. S., & Burm, J. P. (2011). Effects of amlodipine on the pharmacokinetics of warfarin after oral and intravenous administration of warfarin in rats. Biomolecules and Therapeutics, 19(4), 493–497. https://doi.org/10.4062/biomolther.2011.19.4.493
Demir, N., Yucelen, S. Y., Cetin, E. G., Kalkan, K. E., Ozturkmen, Y. A., Demir, E., Basat, S., Calim, A., & Altuntas, Y. (2020). Determining INR Awareness of the Patients who Use Warfarin and Rates of Achieving the Target Dosage. The Medical Bulletin of Sisli Hospital, 54(3), 357–363. https://doi.org/10.14744/semb.2019.76993
Dorgalaleh, A., Favaloro, E. J., Bahraini, M., & Rad, F. (2021). Standardization of Prothrombin Time/International Normalized Ratio (PT/INR). International Journal of Laboratory Hematology, 43(1), 21–28. https://doi.org/10.1111/ijlh.13349
Fahmi, A. M., Elewa, H., & El Jilany, I. (2022). Warfarin dosing strategies evolution and its progress in the era of precision medicine, a narrative review. International Journal of Clinical Pharmacy, 44(3), 599–607. https://doi.org/10.1007/s11096-022-01386-8
Faizah, U. R., Sinuraya, R. K., & Putriana, N. A. (2020). Efektivitas Edukasi Daring dalam Terapi Warfarin terhadap Kepatuhan Pasien. Majalah Farmasetika, 5(5), 233. https://doi.org/10.24198/mfarmasetika.v5i5.27817
Ikhtiar, F., Fiannisa, R., Wahyuni, A., & Kurniawati, E. (2021). Gagal Ginjal Akut Akibat Rabdomiolisis yang Diinduksi Status Epileptikus Acute Renal Failure Due to Rhabdomyolysis Induced by Status Epilepticus. Medula, 11(4), 341–345.
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., Gorenek, B., Hess, P. L., Hlatky, M., Hogan, G., Ibeh, C., Indik, J. H., Kido, K., Kusumoto, F., Link, M. S., … Van Wagoner, D. R. (2024). 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. In Circulation (Vol. 149, Issue 1). https://doi.org/10.1161/CIR.0000000000001193
Khan, A. M., Lubitz, S. A., Sullivan, L. M., Sun, J. X., Levy, D., Vasan, R. S., Magnani, J. W., Ellinor, P. T., Benjamin, E. J., & Wang, T. J. (2013). Low serum magnesium and the development of atrial fibrillation in the community: The framingham heart study. Circulation, 127(1), 33–38. https://doi.org/10.1161/CIRCULATIONAHA.111.082511
Kneeland, P. P., & Fang, M. C. (2010). Current issues in patient adherence and persistence: Focus on anticoagulants for the treatment and prevention of thromboembolism. Patient Preference and Adherence, 4, 51–60. https://doi.org/10.2147/ppa.s6101
Li, G., Yang, J., Zhang, D., Wang, X., Han, J., & Guo, X. (2022). Research Progress of Myocardial Fibrosis and Atrial Fibrillation. Frontiers in Cardiovascular Medicine, 9(July), 1–15. https://doi.org/10.3389/fcvm.2022.889706
Linz, D., Gawalko, M., Betz, K., Hendriks, J. M., Lip, G. Y. H., Vinter, N., Guo, Y., & Johnsen, S. (2024). Atrial fibrillation: epidemiology, screening and digital health. The Lancet Regional Health - Europe, 37, 100786. https://doi.org/10.1016/j.lanepe.2023.100786
Lucà, F., & Parrini, I. (2025). The Elderly Patient with Atrial Fibrillation: Optimal Treatment Strategies. Journal of Clinical Medicine, 14(5), 10–14. https://doi.org/10.3390/jcm14051753
MIMS. (2019). MIMS Petunjuk Konsultasi (19th ed.). Bhuana IlmuPopuler
Musnelina, L., Handayani, F., Vo, T., & Pontoan, J. (2023). Trends in use of Direct Oral Anticoagulants and Warfarin in Atrial Fibrillation Patients. 21(2), 264–270.
Nicolas, D., Elmouhayyar, C., Nicolas, S., Talj, J., Hattar, L., & Alhudairy, M. (2020). Subtherapeutic INR due to warfarin interaction with smokeless tobacco. Journal of Thrombosis and Haemostasis, 18(11), 2954–2957. https://doi.org/10.1111/jth.15057
Ningrum, V. DA, Dyah Widyastuti, I., Sufriyanto Yusuf, B., & Dullah, W. (2020). Bleeding Incidence in Patients Administered with Warfarin at Secondary Hospitals in Yogyakarta Province. Indonesian Journal of Pharmacy, 31(3), 217–228.
Octasari, P. M., & Silvianingsih, N. (2022). Kesesuaian Nilai INR ( International Normalized Ratio ) Pasien Kardiovaskuler Dengan Terapi Warfarin Di Poli Spesialis Jantung RS Roemani Muhammaddiyah This study aims to determine the suitability of the INR value in cardiovascular patients with warfarin. Cendikia Journal of Pharmacy, 6(1), 46–54.
PERKI. (2019). Pedoman Tata Laksana Fibrilasi Atrium Non-Valvular (2nd ed.). PT. Trans Medical International.
Price, E. L., & Ansell, J. (2022). Virtual Education for Patient Self-Testing for Warfarin Therapy Is Effective During the COVID-19 Pandemic. The Joint Commission Journal on Quality and Patient Safety, 48(4), 214–221. https://doi.org/10.1016/j.jcjq.2022.01.001
Putri, N. A., Lestari, K., Diantini, A., & Rusdian, T. (2012). Monitoring Terapi Warfarin pada Pasien Pelayanan Jantung pada Rumah Sakit di Bandung. Jurnal Farmasi Klinik Indonesia, 1(3), 110–116.
Rahmatini, R., Aliska, G., Usman, E., Yanni, M., & Ilmiawati, C. (2020). Plasma warfarin level and international normalized ratio do not correlate with bleeding events in indonesian patients of minangkabau ethnicity with atrial fibrillation. Open Access Macedonian Journal of Medical Sciences, 8(B), 192–197. https://doi.org/10.3889/OAMJMS.2020.3436
Rodríguez-Vélez, R., Ortiz-Rivera, O. J., Bower, B., Gorowski, K., Windemuth, A., Villagra, D., Kocherla, M., Seip, R. L., D’Agostino, D., Vergara, C., Ruaño, G., & Duconge, J. (2010). Exposure to non-therapeutic INR in a high risk cardiovascular patient: Potential hazard reduction with genotype-guided warfarin (coumadin®) dosing. Puerto Rico Health Sciences Journal, 29(4), 402–408.
Scridon, A. (2022). Autonomic imbalance and atrial ectopic activity—a pathophysiological and clinical view. Frontiers in Physiology, 13(December), 1–16. https://doi.org/10.3389/fphys.2022.1058427
Sensuwaty, Widiastuti, H. P., & Firdaus, R. (2023). Kualitas Hidup Pasien Atrial Fibrilasi Post Rawat Inap Di RSD dr. H. Soemarno Sosroatmodjo Tanjung Selor. Aspiration of Health Journal, 01(02), 230–239. https://doi.org/https://doi.org/10.55681/aohj.v1i2.103
Shin, J., Andrews, M., DeJean, L., Debski, N., Exarchakis, A., Fleming, J., Gandhi, R., Hum, C., Kalladanthyil, A., Maddigunta, R., Napoli, L., Nguyen, C., Paul, R., Schmalbach, N., Sichel, J., Snyder, S., Stern, M., Thampi, S., Viggiano, J., … Roy, S. (2023). Risk Factors Associated With Atrial Fibrillation in Elderly Patients. Journal of Clinical Medicine Research, 15(3), 148–160. https://doi.org/10.14740/jocmr4884
Staerk, L., Sherer, J. A., Ko, D., Benjamin, E. J., & Helm, R. H. (2018). Atrial Fibrillation: Epidemiology, Pathophysiology, and Clinical Outcome. Circ Res, 120(9), 1501–1517. https://doi.org/10.1161/CIRCRESAHA.117.309732
Tan, J. L., Johnson, L., Dziubinski, M., Napiorkowski, N., Witkowska, O., Slusarczyk, M. E., Healey, J. S., & Russo, A. M. (2022). Sex differences in presentation of atrial fibrillation: Findings from 30-day ambulatory monitoring in real-world practice. American Heart Journal Plus: Cardiology Research and Practice, 22(September), 100208. https://doi.org/10.1016/j.ahjo.2022.100208
Tana, M., Tana, C., Guglielmi, M. D., Stefanelli, A., Mantini, C., & Porreca, E. (2024). Current Perspectives on Atrial Amyloidosis: A Narrative Review. Reviews in Cardiovascular Medicine, 25(2). https://doi.org/10.31083/j.rcm2502073
Tang, Y., Chen, Q., Liang, B., Peng, B., Wang, M., Sun, J., Liu, Z., Zha, L., & Yu, Z. (2022). A retrospective cohort study on the association between early coagulation disorder and short-term all-cause mortality of critically ill patients with congestive heart failure. Frontiers in Cardiovascular Medicine, 9. https://doi.org/10.3389/fcvm.2022.999391
Tran, C., Yeap, B. B., Ball, J., Clayton-chubb, D., Hussain, M., Brodtmann, A., & Tonkin, A. M. (2024). Articles Testosterone and the risk of incident atrial fi brillation in older men : further analysis of the ASPREE study. EClinicalMedicine, 72, 1–9. https://doi.org/10.1016/j.eclinm.2024.102611
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Published
2025-08-09
How to Cite
Aisyah, V., Futihat, C., & Arianti, A. (2025). The Suitability of INR (International Normalized Ratio) of Atrial Fibrillation Patients with Warfarin Therapy in Hospital “X” Jakarta January - December 2024. Sainstech Farma: Jurnal Ilmu Kefarmasian, 18(2), 91-97. https://doi.org/https://doi.org/10.37277/sfj.v18i2.2355
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Articles
