Meta-Analysis to Assess the Quality of International Normalized Ratio Control and Associated Outcomes in Venous Thromboembolism Patients

Extended treatment of venous thromboembolism: a systematic review and network meta-analysis

“…For extended VTE treatment, our study suggested that DOACs had a numerically, though not significantly, lower risk of major bleeding than standard-intensity VKAs did. It has to be noted that VKA experienced patients are at lower risk of major bleeding with ongoing treatment than VKA naive patients,16 17 while the quality of VKA management may improve with longer treatment duration and in patients who already have prior exposure 18. Therefore, we were not able to observe significant differences between VKAs and DOACs in the risk of major bleeding by the current study size.…”

Extended Therapy of Venous Thrombosis by Oral Anticoagulants: Focus at Safety

“…Представленные в публикации цифры неутешительны: значение TTR в большинстве про-анализированных публикаций оказалось на уровне 37-63,5%. В то же время нахождение МНО вне терапев-тического диапазона не просто не обеспечивает положи-тельный лечебный эффект, но повышает риск развития геморрагических осложнений, в т. ч. фатальных [13].…”

Individual and monitoring centre influences upon anticoagulation control of AF patients on warfarin: A longitudinal multi‐centre UK‐based study

“…As a result of these findings, interpolated TTR has become a standard measure of quality of warfarin management. Unfortunately, many vitamin K antagonist (VKA)‐treated patients do not achieve a TTR of >70%, with a meta‐analysis of published data suggesting that patients spend an average of 61%, 25% and 14% of their time within, above and below range, respectively . This is important as patients with an individual TTR of less than 70%, or high INR variability, have an increased rate of major bleeding or thromboembolism; those with a TTR of >70% have a 79% reduced risk of stroke compared with those with <30% TTR, and mortality rates are significantly lower in those with a TTR >70% than those not achieving this .…”

“…This is important as patients with an individual TTR of less than 70%, or high INR variability, have an increased rate of major bleeding or thromboembolism; those with a TTR of >70% have a 79% reduced risk of stroke compared with those with <30% TTR, and mortality rates are significantly lower in those with a TTR >70% than those not achieving this . 57% of thrombotic events and 42% of haemorrhage events occur at an INR of <2.0 and >3.0, respectively . Factors influencing TTR are both individual based (iTTR) and centre based (cTTR), with iTTR significantly predicting risk of major haemorrhage, ischaemic stroke and all‐cause mortality and cTTR being a weak predictor of all‐cause mortality .…”

“…Vitamin K antagonist monitoring setting influences TTR with patients managed in anticoagulation clinics and with adherence to a warfarin dosing algorithm having better control and outcomes than those managed in community settings . Thus, for example, patients in North America spend significantly less time in the therapeutic range than those in Europe, where results are best in Sweden, then the United Kingdom (UK), both of which have a similar anticoagulant management system. In the United States (US), however, only about one‐third of patients have access to an anticoagulant clinic, and other strategies which can improve TTR for some patients such as self‐monitoring are less used …”