BACKGROUND The quality of warfarin therapy can be determined by the time in the therapeutic range (TTR) of international normalized ratio (INR). The estimated minimum TTR needed to achieve a benefit from warfarin therapy is ≥ 60%. AIM To determine TTR and the predictors of poor TTR among atrial fibrillation patients who receive warfarin therapy. METHODS A retrospective observational study was conducted at a cardiology referral center in Selangor, Malaysia. A total of 420 patients with atrial fibrillation and under follow-up at the pharmacist led Warfarin Medication Therapeutic Adherence Clinic between January 2014 and December 2018 were included. Patients’ clinical data, information related to warfarin therapy, and INR readings were traced through electronic Hospital Information system. A data collection form was used for data collection. The percentage of days when INR was within range was calculated using the Rosendaal method. The poor INR control category was defined as a TTR < 60%. Predictors for poor TTR were further determined by using logistic regression. RESULTS A total of 420 patients [54.0% male; mean age 65.7 (10.9) years] were included. The calculated mean and median TTR were 60.6% ± 20.6% and 64% (interquartile range 48%-75%), respectively. Of the included patients, 57.6% ( n = 242) were in the good control category and 42.4% ( n = 178) were in the poor control category. The annual calculated mean TTR between the year 2014 and 2018 ranged from 59.7% and 67.3%. A high HAS-BLED score of ≥ 3 was associated with poor TTR (adjusted odds ratio, 2.525; 95% confidence interval: 1.6-3.9, P < 0.001). CONCLUSION In our population, a high HAS-BLED score was associated with poor TTR. This could provide an important insight when initiating an oral anticoagulant for these patients. Patients with a high HAS-BLED score may obtain less benefit from warfarin therapy and should be considered for other available oral anticoagulants for maximum benefit.
and KeywordsObjective To assess whether cardiovascular events are increased after cessation of dual antiplatelet therapy (DAPT) following acute coronary syndrome and to explore predictors for recurrent events after DAPT cessation during long-term follow-up. MethodsWe did a retrospective observational cohort study. We included consecutive people with acute coronary syndrome (ACS) who were discharged from Scottish hospitals between January 2008 and December 2013 and who received DAPT after discharge followed by antiplatelet monotherapy. The rates of cardiovascular events were assessed during each 90-day period of DAPT treatment and 90-day period after stopping DAPT. Cardiovascular events were defined as a composite of death, ACS, transient ischaemic attack or stroke. Cox regression was used to identify predictors of cardiovascular events following DAPT cessation.Results 1340 patients were included (62% male, mean age 64.9(13.0) years). Cardiovascular events occurred in 15.7% (n=211) during the DAPT period (mean DAPT duration 175.1(155.3) days) and in 16.7% (n=188) following DAPT cessation (mean of 2.7 years follow-up).Independent predictors for a cardiovascular event following DAPT cessation were age (hazard ratio (HR) 1.07; 95% confidence interval (CI) 1.05-1.08; p<0.001), DAPT duration (HR 0.997; 95% CI 0.995-0.998; p<0.001) and having revascularization therapy during the index admission (HR 0.58; 95% CI 0.39-0.85; p=0.005). ConclusionsThe rate of cardiovascular events was not significantly increased in the early period post DAPT cessation compared to later periods in this ACS population. Increasing age, DAPT duration and lack of revascularization therapy were associated with increased risk of cardiovascular events during long term follow up after DAPT cessation. Keywords: antiplatelets, DAPT, cardiovascular events, ACS;Word count : 250 words Key messagesWhat is already known on this subject?Discontinuation of dual antiplatelet therapy (DAPT) is associated with an increased risk of cardiovascular disease in previous studies. The association between the duration of DAPT and DAPT cessation is unknown. What might this study add?We found that increasing age, DAPT duration and lack of revascularization therapy for the ACS were associated with increased risk of cardiovascular events during long term follow up after DAPT cessation. How might this impact on clinical practice?Our findings indicate that longer duration of DAPT and use of revascularization therapy may be related to a reduced risk of cardiovascular event after ACS and DAPT cessation.
We found no increased risk in patients who stopped and interrupted antiplatelets early after stroke but the study was limited by a small sample size and further research is needed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.