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June 20, 2026SN Comprehensive Clinical Medicine

Evaluation of Anticoagulation Quality Among Older Adults Receiving Warfarin: A Systematic Review

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Why the study?

What is the quality of anticoagulation (time in therapeutic range) among older adults receiving warfarin, and do structured management strategies improve it?

Population

Adults aged ≥ 60 years receiving warfarin (12 studies: 2 RCTs and 10 observational)

Comparison

Warfarin therapy vs Routine clinical practice

Design

Systematic_review

Key result

Structured management strategies such as pharmacist-led management and genotype-guided dosing improved time in therapeutic range compared to routine care (93% vs. 31.2% and 70.8% vs. 53.44%).

Authors

RARaghad AlrashidiRARenad AlhaqbaniMAMohammed M. Alharbi

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Overview

Suboptimal TTR with warfarin in older adults warrants pharmacist-led or genotype-guided strategies; supports targeted management to improve anticoagulation quality.

Key Points

  • This review aims to evaluate the quality of anticoagulation among older adults receiving warfarin, specifically analyzing TTR and INR patterns.
  • Systematic search of PubMed/MEDLINE and Web of Science from January 2000 to August 2025.
  • Included studies focused on adults aged ≥ 60 years receiving warfarin and reporting TTR.
  • Registered in PROSPERO (CRD420251270126).
  • Twelve studies included: 2 randomized, 10 observational.
  • Observed TTR ranged from 42.6% to 78.6%, indicating variable and suboptimal anticoagulation control.
  • Pharmacist-led management achieved TTR of 93% compared to 31.2% in standard care; genotype-guided dosing improved TTR to 70.8% from 53.44%.

Study Design

Type

Systematic Review

Structured PICO

What is the quality of anticoagulation (time in therapeutic range) among older adults receiving warfarin, and do structured management strategies improve it?

P
Population
Systematic review of 12 studies (2 randomized, 10 observational) evaluating anticoagulation quality among adults aged ≥ 60 years receiving warfarin.
I
Intervention
Warfarin therapy (including structured management strategies like pharmacist-led management and genotype-guided dosing)
C
Comparator
Routine clinical practice
O
Outcome
Time in therapeutic range (TTR) and international normalized ratio (INR) distribution patternssurrogate

Anticoagulation quality among older adults on warfarin is frequently suboptimal in routine practice, but structured management strategies like pharmacist-led or genotype-guided dosing can improve time in therapeutic range.

Cite This Study

Alrashidi et al. (2026) conducted a systematic review in Anticoagulation in older adults. Structured warfarin management (pharmacist-led or genotype-guided) vs. Routine clinical practice was evaluated on Time in therapeutic range (TTR). Structured management strategies such as pharmacist-led management and genotype-guided dosing improved time in therapeutic range compared to routine care (93% vs. 31.2% and 70.8% vs. 53.44%).

synapsesocial.com/papers/6a3722cf01fe431c251889c2https://doi.org/10.1007/s42399-026-02486-6
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Anticoagulation Control and Associated Factors in Patients with Atrial Fibrillation Receiving Warfarin at a Tertiary Care Hospital in Nepal2025
  2. 2Evaluation of Patients Hospitalized Due to Bleeding Complications Associated with Warfarin Treatment2025
  3. 3Nonvalvular Atrial Fibrillation and Anticoagulation in the Elderly: A Retrospective Cohort Study2026
  4. 4Optimizing Time in Therapeutic Range in Patients With HeartMate 3: Pharmacist-Led Anticoagulation Using Pharmacogenetics of Warfarin2026
  5. 5Determinants of Suboptimal INR Control in Eritrean Post–Cardiac Surgery Patients: Insights from a Low-Resource Setting2026