Evaluation of time in therapeutic range in anticoagulated patients: a single-center, retrospective, observational study

Abstract

BackgroundThe percentage of time during which the patients have the INR within the target values (i.e. Time in Therapeutic Range [TTR]) is a measure of anticoagulation quality with Vitamin K Antagonists (VKA). To evaluate the quality of anticoagulation using TTR according to the Rosendaal method, we performed an observational, retrospective study. We included all outpatients who attended the cardiology anticoagulation clinic of a Portuguese hospital (2011–2013), whose target INR was 2.0-3.0.Results377 VKA-treated patients were evaluated. Of these, 72.4% had non-valvular atrial fibrillation. Patients were followed for a mean period of 471 days. The mean TTR was 60.3% (SD 19.3%) and 44.3% of the patients had a mean TTR < 60%. Patients were at high risk of bleeding (INR > 4.5) and at high thrombotic risk (INR < 1.5) during, respectively, 1.7% and 4.7% of the time.ConclusionsAnticoagulation control needs to be improved. These results are informative for all stakeholders: patients, health care professionals, and policymakers.

The efficacy and safety of direct oral anticoagulants vs traditional anticoagulants in cirrhosis

“…This is in line with prior studies of DOACs, which have been routinely found to have less CNS bleeding . The majority of the patients in the traditional anticoagulation group were receiving VKAs, which are prone to significant time outside of the therapeutic range . It is possible that supratherapeutic values in patient with cirrhosis are more dangerous than in patients without hepatic impairment, and while DOAC metabolism in cirrhosis may lead to higher mean therapeutic levels with certain DOACs, it is likely consistent, with less extreme peaks and troughs.…”

A Prospective Observational Study to Assess the Quality of Warfarin Therapy and Validate the Impact of Has Bled and Cha2ds2-Vasc Score in the Prevention of Stroke in Indian Atrial Fibrillation Patients

“…9 But Daniel Caldeira et al reported 44.3% of their patients who had a mean TTR < 60%, were at an increased risk of thrombotic and hemorrhagic events. 10 Even the larger randomized trials of newer oral anticoagulants and warfarin in Atrial fibrillation, provided further data about worldwide difficulty in maintaining the TTR level. The mean TTR values of the major large randomized trials (ROCKET-AF trial, ARISTOTLE trial and the RELY trial) were 55.2%, 62.2% and 64%.…”

Factores asociados a la anticoagulación oral óptima en el adulto mayor con fibrilación auricular

“…Se calculó el TRT mediante el método de Rosendaal (18,19,20), considerándose como control óptimo TRT ≥60% y control subóptimo TRT <60%. Este es el valor utilizado en los estudios clínicos internacionales (19,20).…”

“…Se calculó el TRT mediante el método de Rosendaal (18,19,20), considerándose como control óptimo TRT ≥60% y control subóptimo TRT <60%. Este es el valor utilizado en los estudios clínicos internacionales (19,20). Los grupos fueron sometidos a análisis para determinar la asociación con los factores edad, género, grado de instrucción, dependencia funcional, deterioro cognitivo, comorbilidades, discontinuidad terapéutica y polifarmacia, así como el porcentaje de ACV y sangrado en ambos grupos.…”