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All Journal Jurnal Sehat Indonesia (JUSINDO) Indonesian Health Journal
Wenny Putri Nilamsari
Universitas Airlangga
Dentistry Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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Evaluation of Warfarin Therapy and Achievement of Target Time in Therapeutic Range in Patients with Atrial Fibrillation at Cardiac Care Center Outpatient Clinic of Dr. Soetomo General Hospital Della Novinta; Amaliyah R.Z.; Wenny Putri Nilamsari; Mochammad Yusuf; Endang Martiniani
Jurnal Sehat Indonesia (JUSINDO) Vol. 8 No. 2 (2026): Jurnal Sehat Indonesia (JUSINDO)
Publisher : CV. Publikasi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59141/-.v8i2.565

Abstract

Warfarin remains an important oral anticoagulant for patients with atrial fibrillation (AF); however, achieving adequate anticoagulation requires appropriate prescribing, individualized dose adjustment, and regular monitoring. This study evaluated warfarin utilization, drug-related problems, and achievement of target time in therapeutic range (TTR) among patients with AF at the Integrated Cardiac Care Center Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. This retrospective observational study reviewed the medical records of 106 eligible patients who attended the clinic between December 2023 and January 2024. Warfarin indications, dosing practices, international normalized ratio (INR) monitoring intervals, potential drug–drug interactions, and suspected adverse drug reactions were evaluated. TTR was calculated using the Rosendaal linear interpolation method. Appropriate indications for warfarin therapy were identified in 83.96% of patients. Mean concordance with the warfarin dosing algorithm was 43.20%, while 35.48% of 885 INR monitoring events occurred within the recommended monitoring intervals. Sixty-five potential drug–drug interaction events and nine bleeding events classified as Bleeding Academic Research Consortium (BARC) type 2 were documented. The mean TTR was 43.15 ± 25.28%, and only 18.87% of patients achieved a TTR ≥65%. These findings indicate that appropriate indications for warfarin therapy did not consistently correspond to adequate anticoagulation control. Warfarin management should therefore emphasize individualized dose adjustment, timely INR monitoring, and systematic medication review. These findings provide a basis for improving anticoagulation management services; however, the retrospective observational design precludes causal inference.
Drug Utilization of Statin Therapy in Patients with Acute Coronary Syndrome at the Cardiology and Cardiovascular Outpatient Clinic of Airlangga University Hospital Eunike Christiane Hartanto; Deny Wilson Amanda Sitorus; Wenny Putri Nilamsari; Budi Susetyo Pikir; Marcha Debby Saraswati
Indonesian Health Journal Vol. 5 No. 3 (2026): Indonesian Health Journal
Publisher : Riviera Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58344/ihj.v5i3.921

Abstract

Acute coronary syndrome (ACS) remains a major cause of cardiovascular morbidity and mortality, and intensive low-density lipoprotein cholesterol (LDL-C) reduction with high-intensity statin therapy is essential for secondary prevention. This study aimed to evaluate statin utilization, treatment appropriateness, drug-related problems, and LDL-C target attainment among patients with ACS. A retrospective observational study was conducted at the Cardiology and Cardiovascular Outpatient Clinic of Universitas Airlangga Hospital, Surabaya, Indonesia. Medical records of patients treated from July to December 2023 were reviewed, and 51 eligible patients receiving statin therapy were included using total sampling. Data were analyzed descriptively. Moderate-intensity statins predominated; simvastatin 20 mg was the most frequently prescribed statin during the first month, whereas atorvastatin 20 mg predominated during the second month, while atorvastatin 40 mg use remained limited. Inappropriate statin therapy was identified in 45 patients (88.24%), including inadequate statin intensity and insufficient treatment duration. Only two patients (3.9%) achieved the recommended LDL-C target of ?55 mg/dL, both after receiving atorvastatin 40 mg. Suspected statin-associated muscle symptoms occurred in four patients (7.84%), while several potential drug–drug interactions were documented. These findings demonstrated that statin therapy for secondary prevention remained suboptimal, highlighting the need for guideline-concordant prescribing, regular LDL-C monitoring, and systematic management of identified drug-related problems.
Co-Authors Amaliyah R.Z. Budi Susetyo Pikir Della Novinta Deny Wilson Amanda Sitorus Endang Martiniani Eunike Christiane Hartanto Marcha Debby Saraswati Mochammad Yusuf