How to manage patients on vitamin k antagonists in the covid-19 era

Introduction: many healthcare resources have been and continue to be allocated to the management of patients with COVID-19 This pandemic influenced our healthcare system aiming at a minimum of contact between patients and professionals We tried to study the impact of this disease, on cardiac patients under anticoagulation with vitamin K antagonists (VKA) and to propose an algorithm to facilitate their monitoring Materials and method: This is a retrospective, descriptive study including patients on VKA hospitalized at the Ariana cardiology department or arriving at the outpatient clinic or contacted by telephone during the month of August 2020 Results: A total of 100 patients were collected The average age was 61 59 years old 58% of the patients did not know their target international normalized ratio (INR) During lockdown period, only 49% of patients monitored their INR 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 while 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 monitoring and an INR after lockdown in a therapeutic zone (p = 0 000) In the light of our results, we proposed an algorithm for the management of anticoagulant therapy in uninfected patients Conclusion: The need to observe social distancing or lockdown rules should not affect the quality and safety of anticoagulant therapy Therefore, we strongly urge clinicians to ensure patients receiving VKA therapy are appropriately managed despite the COVID-19 crisis