Assessment of the Quality of Chronic Anticoagulation Control With Time in Therapeutic Range in Atrial Fibrillation Patients Treated With Vitamin K Antagonists by Hemostasis Specialists: The TERRA Registry: Tiempo en rango en la República Argentina

Abstract

In this multicenter study, mean TTR values in patients with AF under VKA were similar to those in international therapeutic clinical trials (55%-65%). Marked variations among institutions were observed and, although average results obtained were high, one third of the patients exhibited a TTR below 60%. This cutoff value is conservative according to current recommendations, and guidelines suggest that when management with VKA cannot be improved, patients should be switched to direct oral anticoagulants. The addition of TTR calculation to clinical practice may help improve the quality of oral anticoagulation in patients with AF, thus improving anticoagulation outcomes.

Comparing the effectiveness of pharmacist‐managed warfarin anticoagulation with other models: a systematic review and meta‐analysis

“…The percentage of time within the therapeutic range is a useful surrogate marker to assess the quality of treatment with warfarin. A clear correlation was observed between the percentage of time within the therapeutic range and the risk of bleeding or embolism . Furthermore, a recent European consensus document recommends that the average time in the therapeutic range should be >70% for optimal efficacy and safety outcomes while on warfarin and this is also recommended in the European Guidelines .…”

“…A clear correlation was observed between the percentage of time within the therapeutic range and the risk of bleeding or embolism. [27][28][29] Furthermore, a recent European consensus document recommends that the average time in the therapeutic range should be >70% for optimal efficacy and safety outcomes while on warfarin and this is also recommended in the European Guidelines. 30 In the National Institute for Health and Care Excellence guidelines, the percentage of time within the therapeutic range >65% is recommended for patients with AF who are on warfarin anticoagulation therapy.…”

A mechanical heart valve is the best choice

“…They noted that with education and regular follow-up, the mean TTR was 64.6% in all-comers, but in the group with mechanical heart valves, the mean TTR was 77% 20. Though the mean TTR for all-comers is numerically lower than the TTR achieved in the Australian clinic, it is again comparable to a TTR achieved in well-conducted clinical trials of warfarin 21. Importantly, the subset of patients with a mechanical heart valve achieved similar outcomes to the Australian group,20 thereby suggesting that a rural setting and living in a developed nation do not necessarily disadvantage or advantage patients in the management of outpatient anticoagulation.…”

“…Using education, protocols and point-of-care INR devices, they report a time in therapeutic range (TTR) of 69% using the standard INR range of 2.0–3.0 and 81% using a slightly expanded range of 1.8–3.0 19. They further describe that with the adoption of testing every 14 days, the TTR was as high as 78%, a result that rivals even the best-conducted clinical trials of warfarin 19 21. Again, it may be argued that Australia is a developed nation and a similar outcome would be harder to achieve in a low/middle-income nation due to a lack of resources.…”

Prognostic value of the SAMe-TT2R2 index and Charlson Comorbidity Index for the non-target anticoagulation and risk of thrombotic events in warfarin-treated patients (results of 10-years prospective study)

“…Так, по данным рандомизированных клинических иссле-дований, сравнивающих прямые пероральные антикоагулянты с варфарином, число пациентов, находящихся в целевом диапазоне МНО, составляет 58-67% [5][6][7]. Данные регистров свидетельствуют, что в условиях реальной клинической практики вне целевой антикоагуляции находятся от 40 до 60% пациентов [8][9][10][11][12]. Наблюдение больных в условиях коагуляционных клиник и кабинетов повышает стабильность значений МНО, однако и в таких условиях число пациентов с нецелыми значениями TTR достигает 30% [13,14].…”