scholarly journals Evaluation of the impact of warfarin time in therapeutic range on outcomes of patients with atrial fibrillation in Turkey: Perspectives from the observational, prospective WATER Registry

2015 ◽  
Vol 22 (5) ◽  
pp. 567-575 ◽  
Author(s):  
Ugur Onsel Turk ◽  
Esref Tuncer ◽  
Emin Alioglu ◽  
Kivanc Yuksel ◽  
Nihat Pekel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Time In Therapeutic Range ◽  
The Impact

THE IMPACT OF TEMPORARY INTERRUPTIONS OF WARFARIN ON DOWNSTREAM TIME IN THERAPEUTIC RANGE IN PATIENTS WITH ATRIAL FIBRILLATION: RESULTS FROM ORBIT AF

2019 ◽  
Vol 73 (9) ◽  
pp. 468
Author(s):  
Malini Madhavan ◽  
DaJuanicia N. Holmes ◽  
Jonathan Piccini ◽  
James Freeman ◽  
Gregg Fonarow ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Time In Therapeutic Range ◽  
The Impact

Impact of provision of time in therapeutic range value on anticoagulation management in atrial fibrillation patients on warfarin

2018 ◽  
Vol 94 (1110) ◽  
pp. 207-211 ◽  
Author(s):  
Duo Huang ◽  
Chi-Lap Wong ◽  
Kwan-Wa Cheng ◽  
Pak-Hei Chan ◽  
Wen-Sheng Yue ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Clinic Visit ◽  
Controlled Study ◽  
Anticoagulation Management ◽  
Time In Therapeutic Range ◽  
Randomised Controlled Study ◽  
The Mean ◽  
Randomised Controlled ◽  
The Impact

IntroductionThe importance of time in therapeutic range (TTR) in patients prescribed warfarin therapy for stroke prevention in atrial fibrillation (AF) cannot be overemphasised.AimTo evaluate the impact of provision of TTR results during clinic visits on anticoagulation management.DesignSingle-centred, randomised controlled study.SettingFifteen arrhythmia clinics in Hong Kong.PatientsAF patients prescribed warfarin.InterventionsProvision of TTR or no provision of TTR.Main outcome measuresA documented discussion between doctors and patients about switching warfarin to a non-vitamin K oral anticoagulant (NOAC).ResultsFour hundred and eighty one patients with AF prescribed warfarin were randomly assigned to (1) a TTR provision group or (2) control. Their mean age was 73.6±12.0 years and 60.7% were men. The mean CHA2DS2-VASc score was 3.2±1.6 and the mean HASBLED score was 1.7±1.2. The mean TTR was 63.9%±29.9%. At the index clinic visit, 71 of 481 patients (14.8%) had a documented discussion about switching warfarin to a NOAC. Patients with provision of TTR results were more likely to discuss switching warfarin to a NOAC than controls (19.1% vs 10.6%, P=0.03), especially those with a TTR <65% (35.2% vs 10.6%, P<0.001). A higher proportion of patients with provision of TTR results switched to a NOAC (5.9% vs 4.1%, P=0.49).ConclusionsThe provision of TTR among patients on warfarin was associated with a discussion about switching from warfarin to a NOAC in those with TTR <65%, but did not result in actual switching to a NOAC, suggesting additional barriers.

Renal Function, Time in Therapeutic Range and Outcomes in Warfarin-Treated Atrial Fibrillation Patients: A Retrospective Analysis of Nationwide Registries

2017 ◽  
Vol 117 (12) ◽  
pp. 2291-2299 ◽  
Author(s):  
Anders Bonde ◽  
Gregory Lip ◽  
Anne-Lise Kamper ◽  
Laila Staerk ◽  
Christian Torp-Pedersen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Therapeutic Range ◽  
Cox Regression ◽  
International Normalized Ratio ◽  
Adverse Outcomes ◽  
Time In Therapeutic Range ◽  
Anticoagulation Control ◽  
The Impact ◽  
Reduced Renal Function

AbstractPatients with severely reduced renal function have been excluded from randomized controlled trials of oral anticoagulation in atrial fibrillation (AF). Warfarin treatment in this population is controversial and data on anticoagulation control and the impact on adverse outcomes are needed. By individual-level linkage of nationwide registries, we identified all patients discharged from hospitals with AF in Denmark between 1997 and 2011. Patients with available serum creatinine tests were categorized according to the estimated glomerular filtration rate (eGFR). Time in therapeutic range (TTR) was calculated using the Rosendaal method. The risk of stroke and bleeding was estimated using multivariable Cox regression analyses with eGFR and TTR estimated time dependently throughout follow-up. We identified 10,423 warfarin-treated AF patients with available international normalized ratio and creatinine tests; 5,527 with eGFR > 60 mL/min/1.73 m2, 4,524 with eGFR 30–60 mL/min/1.73 m2 and 372 with eGFR < 30 mL/min/1.73 m2. Median TTR was 66.7, 61.2 and 49.7% in patients with eGFR > 60, 30–59 and <30 mL/min/1.73 m2, respectively. A TTR < 70% was associated with a higher risk of stroke/thromboembolism (hazard ratio [HR]: 1.39; 95% confidence interval [CI]: 1.20–1.60) and bleeding (HR: 1.22; 95% CI: 1.05–1.42) among patients with eGFR of 30 to 59 and a trend towards higher risk of stroke/thromboembolism (HR: 1.24; 95% CI: 0.86–1.80) and bleeding (HR: 1.17; 95% CI: 0.83–1.65) among patients with eGFR < 30 mL/min/1.73 m2. In conclusion, warfarin-treated AF patients with reduced renal function have suboptimal anticoagulation control which was related to the risk of adverse outcomes.

Use of SAMe-TT₂R₂ Score to Predict the Quality of Anticoagulation Control in Patients with Atrial Fibrillation Receiving Warfarin in Thailand

2020 ◽  
Vol 103 (6) ◽  
pp. 548-552
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Statistical Significance ◽  
Discrimination Performance ◽  
Poor Quality ◽  
Chi Square ◽  
Exact Test ◽  
Time In Therapeutic Range ◽  
Anticoagulation Control

Objective: To predict the quality of anticoagulation control in patients with atrial fibrillation (AF) receiving warfarin in Thailand. Materials and Methods: The present study retrospectively recruited Thai AF patients receiving warfarin for three months or longer between June 2012 and December 2017 in Central Chest Institute of Thailand. The patients were classified into those with SAMe-TT₂R₂ of 2 or less, and 3 or more. The Chi-square test or Fisher’s exact test was used to compare the proportion of the patients with poor time in therapeutic range (TTR) between the two groups of SAMe-TT₂R₂ score. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics. Results: Ninety AF patients were enrolled. An average age was 69.89±10.04 years. Most patients were persistent AF. An average CHA₂DS₂-VASc, SAMe-TT₂R₂, and HAS-BLED score were 3.68±1.51, 3.26±0.88, and 1.98±0.85, respectively. The present study showed the increased proportion of AF patients with poor TTR with higher SAMe-TT₂R₂ score. The AF patients with SAMe-TT₂R₂ score of 3 or more had a larger proportion of patients with poor TTR than those with SAMe-TT₂R₂ score of 2 or less with statistical significance when TTR was below 70% (p=0.03) and 65% (p=0.04), respectively. The discrimination performance of SAMe-TT₂R₂ score was demonstrated with c-statistics of 0.60, 0.59, and 0.55 when TTR was below 70%, 65% and 60%, respectively. Conclusion: Thai AF patients receiving warfarin had a larger proportion of patients with poor TTR when the SAMe-TT₂R₂ score was higher. The score of 3 or more could predict poor quality of anticoagulation control in those patients. Keywords: Time in therapeutic range, Poor quality of anticoagulation control, Warfarin, SAMe-TT₂R₂, Labile INR

Net Clinical Benefit of Dabigatran Over Warfarin in Patients With Atrial Fibrillation Stratified by CHA2DS2-VASc and Time in Therapeutic Range

2016 ◽  
Vol 32 (10) ◽  
pp. 1247.e15-1247.e21 ◽  
Author(s):  
Pak-Hei Chan ◽  
Duo Huang ◽  
Chu-Pak Lau ◽  
Esther W. Chan ◽  
Ian C.K. Wong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Therapeutic Range ◽  
Clinical Benefit ◽  
Time In Therapeutic Range ◽  
Net Clinical Benefit

scholarly journals Vitamin K Antagonist Treatment in Patients With Atrial Fibrillation and Time in Therapeutic Range in Four European Countries

2014 ◽  
Vol 36 (9) ◽  
pp. 1160-1168 ◽  
Author(s):  
François-Emery Cotté ◽  
Hicham Benhaddi ◽  
Isabelle Duprat-Lomon ◽  
Adam Doble ◽  
Nick Marchant ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Therapeutic Range ◽  
Vitamin K Antagonist ◽  
European Countries ◽  
Time In Therapeutic Range

scholarly journals Poor Time in Therapeutic Range Control is Associated with Adverse Clinical Outcomes in Patients with Non-Valvular Atrial Fibrillation: A Report from the Nationwide COOL-AF Registry

2020 ◽  
Vol 9 (6) ◽  
pp. 1698 ◽  
Author(s):  
Rungroj Krittayaphong ◽  
Thoranis Chantrarat ◽  
Roj Rojjarekampai ◽  
Pongpun Jittham ◽  
Poom Sairat ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Therapeutic Range ◽  
Major Bleeding ◽  
Stroke Prevention ◽  
International Normalized Ratio ◽  
Time In Therapeutic Range ◽  
Hazard Ratios ◽  
The Relationship

Background: Warfarin remains the most commonly used oral anticoagulant (OAC) in Thailand for stroke prevention among patients with non-valvular atrial fibrillation (NVAF). The aim of this study was to investigate the relationship between time in therapeutic range (TTR) after warfarin initiation and clinical outcomes of NVAF. Methods: TTR was calculated by the Rosendaal method from international normalized ratio (INR) data acquired from a nationwide NVAF registry in Thailand. Patients were followed-up every six months. The association between TTR and clinical outcomes was analyzed. Results: There was a total of 2233 patients from 27 hospitals. The average age was 68.4 ± 10.6 years. The average TTR was 53.56 ± 26.37%. Rates of ischemic stroke/TIA, major bleeding, ICH, and death were 1.33, 2.48, 0.76, and 3.3 per 100 person-years, respectively. When patients with a TTR < 65% were compared with those with TTR ≥ 65%, the adjusted hazard ratios (aHR) for the increased risks of ischemic stroke/TIA, major bleeding, ICH, and death were 3.07, 1.90, 2.34, and 2.11, respectively. Conclusion: Poor TTR control is associated with adverse clinical outcomes in patients with NVAF who were on warfarin. Efforts to ensure good TTR (≥65%) after initiation of warfarin are mandatory to minimize the risk of adverse clinical outcomes.

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