Risks of stroke and mortality associated with suboptimal anticoagulation in atrial fibrillation patients

Atrial fibrillation (AF) carries an increased risk of ischaemic stroke, and oral anticoagulation with warfarin can reduce this risk. The objective of this study was to evaluate the association between time in therapeutic International Normalised Ratio (INR) range when receiving warfarin and the risk...

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Vydáno v:Thrombosis and haemostasis Ročník 106; číslo 5; s. 968
Hlavní autoři: Gallagher, A M, Setakis, E, Plumb, J M, Clemens, A, van Staa, T-P
Médium: Journal Article
Jazyk:angličtina
Vydáno: Germany 01.11.2011
Témata:
Adult
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Atrial Fibrillation - blood
Atrial Fibrillation - complications
Atrial Fibrillation - drug therapy
Atrial Fibrillation - mortality
Blood Coagulation - drug effects
Databases as Topic
Drug Monitoring - methods
Female
General Practice
Humans
International Normalized Ratio
Kaplan-Meier Estimate
Male
Middle Aged
Odds Ratio
Proportional Hazards Models
Risk Assessment
Risk Factors
Stroke - blood
Stroke - etiology
Stroke - mortality
Stroke - prevention & control
Time Factors
Treatment Outcome
United Kingdom
Warfarin
ISSN:0340-6245, 2567-689X, 2567-689X
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Shrnutí:Atrial fibrillation (AF) carries an increased risk of ischaemic stroke, and oral anticoagulation with warfarin can reduce this risk. The objective of this study was to evaluate the association between time in therapeutic International Normalised Ratio (INR) range when receiving warfarin and the risk of stroke and mortality. The study cohort included AF patients aged 40 years and older included in the UK General Practice Research Database. For patients treated with warfarin we computed the percentage of follow-up time spent within therapeutic range. Cox regression was used to assess the association between INR and outcomes while controlling for patient demographics, health status and concomitant medication. The study population included 27,458 warfarin-treated (with at least 3 INR measurements) and 10,449 patients not treated with antithrombotic therapy. Overall the warfarin users spent 63% of their time within therapeutic range (TTR). This percentage did not vary substantially by age, sex and CHA2DS2-VASc score. Patients who spent at least 70% of time within therapeutic range had a 79% reduced risk of stroke compared to patients with ≤30% of time in range (adjusted relative rate of 0.21; 95% confidence interval 0.18-0.25). Mortality rates were also significantly lower with at least 70% of time spent within therapeutic range. In conclusion, good anticoagulation control was associated with a reduction in the risk of stroke.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:0340-6245
2567-689X
2567-689X
DOI:10.1160/TH11-05-0353