Abstract
Background: Anticoagulation clinic has been implemented in Thailand with considerable success,
mostly in tertiary care hospitals. To improve accessibility of such service, a satellite network of anticoagulation
clinics in rural area was recently implemented. Objective: To compare quality of anticoagulant
control, complications and follow-up frequency among patient receiving warfarin therapy during their
attendance to a tertiary care center versus after referral to satellite clinics. Methods: Satellite network of
anticoagulation clinic was established at the Nakornratchasima province in early 2009 comprising of 4
community hospitals and a community medical unit. Patients receiving warfarin for at least 6 months at a
tertiary care hospital, who were clinically stable, were consented and enrolled in satellite clinics. Data on
anticoagulation control and other outcome variable of pre-referral period were compared with those of
post-referral period using descriptive statistics, paired T-test and McNemar’s test, where appropriate.
Results: Sixty nine patients were enrolled with a total number of 273 visits. Mean age was 56.2 ± 13.7 years
old. Most common indications were prosthetic valve replacement (40.6 %), rheumatic heart disease (20.2
%), atrial fibrillation with stroke (17.3%) and other (21.7 %). For anticoagulation control, time in target
range of patients during pre-referral and post-referral periods were similar (46.5 % vs 46.1 %; p = 0.94).
Incidence of INR value < 1.5 or > 4.0 were similar between the two groups but numerically lower in the
post-referral period (20.0 % in pre-referral vs 17.2 % in post referral periods: p=0.25). No major complication
was reported. Follow-up interval was shorter with satellite clinics (4.5 week/visit and 8.5 week/
visit). Conclusion: Satellite network of anticoagulation clinic can provide quality anticoagulation control
similar to a tertiary care setting. In addition, such service may improve safety of warfarin therapy through
a close monitoring system and improved accessibility.
