Optimal Intensity of International Normalized Ratio in Warfarin Therapy for Secondary Prevention of Stroke in Patients with Non-valvular Atrial Fibrillation.

Yasaka, Masahiro; Minematsu, Kazuo; Yamaguchi, Takenori

doi:10.2169/internalmedicine.40.1183

Cited by 203 publications

(145 citation statements)

References 15 publications

(12 reference statements)

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“…For example, a study from Japan reported that the lowest effective international normalized ratio (INR) for stroke prevention in their population was only 1.6. 10 As a result, there is a clinical dilemma on the use of anticoagulation therapy in Chinese non-valvular AF patients with concomitant hypertension. Currently, we are unaware of any data on the safety and efficacy of anticoagulation therapy in Chinese patients with hypertension and associated AF.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

Siu

Yue

et al. 2010

J Hum Hypertens

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Limited evidence is available on the safety and efficacy of anticoagulants in non-valvular atrial fibrillation (AF) patients with concomitant hypertension. We investigated the safety and efficacy of 476 consecutive anticoagulated Chinese outpatients with non-valvular AF and hypertension. Occurrence of ischaemic stroke and major bleeding, and international normalized ratio (INR) values during these events were recorded. There was no significant difference in anticoagulation control between patients with or without hypertension. INRspecific incidence rates of the events were calculated, which showed no excessive risk for ischaemic stroke (2.5 vs 1.6% per year, P ¼ 0.22) or major bleeding (3.9 vs 3.2% per year, P ¼ 0.29) in non-valvular AF patients with or without hypertension. In multivariate analysis, congestive heart failure, smoking and high CHADS2 score were independent predictors for ischaemic stroke, whereas use of antiplatelet agents was an independent predictor for bleeding. It can be noted that hypertension was not associated with ischaemic stroke or major bleeding. Hypertensive patients who achieved target blood pressure control (o130/80 mm Hg) had a lower ischaemic stroke (0.9 vs 3.1% per year, P ¼ 0.01), but similar bleeding risk compared with those not achieving target blood pressure. Our findings demonstrate the effects of hypertension on the outcomes of warfarin therapy; further investigation is needed to clarify whether more aggressive antihypertensive therapy could result in better outcomes in hypertensive patients with non-valvular AF.

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Section: Introductionmentioning

confidence: 99%

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

Siu

Yue

et al. 2010

J Hum Hypertens

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“…12) Major hemorrhage occurs in 4.4% of patients with an PT-INR of 2.30-3.56. 13) The hemorrhagic tendency does seem to increase with addition of antiplatelet drugs. Hemorrhagic complication occurs in 6.2% of patients who receive aspirin and warfarin.…”

Section: Discussionmentioning

confidence: 99%

Acute Subdural Hematoma in Patients With Medication Associated With Risk of Hemorrhage

Oyama

Kito

Maki

et al. 2011

Neurol. Med. Chir.(Tokyo)

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The characteristics of 90 cases of acute subdural hematoma were analyzed in 25 patients taking medication related to bleeding tendency, the bleeding tendency group, and 65 patients without such medication, the control group. Acute subdural hematoma was significantly associated with over-turning or without accident in the bleeding tendency group (92%) compared with the control group (56.9%). The time from trauma to admission was significantly longer in the bleeding tendency group (32.7 hours) compared with the control group (9.7 hours). The mean Glasgow Coma Scale score on admission was 13.0 points in the bleeding tendency group and was significantly better than 10.9 points in the control group. The international normalized ratio of prothrombin time on admission was 3.59 in the patients treated with warfarin. All patients taking warfarin received reversal agents and this value decreased significantly to 1.38. In the bleeding tendency group, hematoma size increased in 20% after the operation, almost the same as in the control group (25%). Although good recovery tended to be observed less frequently in the bleeding tendency group than in the control group, the mean age of the bleeding tendency group was significantly higher than that of the control group, so the prognosis might be affected by this age-related factor. Cautious diagnosis, follow-up imaging, and strict management are mandatory in patients with bleeding tendency.

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“…The trial was stopped due to a significantly greater rate of major hemorrhagic complications (6.6% per year) in the conventional intensity group (INR 2.2-3.5) than low intensity anticoagulation group (INR 1.5-2.1) (0% per year), although the annual ischemic stroke rate was low in both groups (1.1 % in the conventional group and 1.7 % in the low intensity group). Nonetheless, the number of patients in this study was too small for a definite risk/benefit assessment 32) . On the basis of this study, and other evidence, the Japanese AF guidelines recommend a target INR of 1.6-2.6 in patients with non-valvular AF aged ≥70 years 33) (Fig.…”

Section: Should a Lower Therapeutic Inr Range Be Considered For Some mentioning

confidence: 91%

“…In a secondary prevention trial, Yamaguchi et al studied 115 patients with NVAF who were less than 80 years old and had had a stroke or transient ischemic attack 32) . The trial was stopped due to a significantly greater rate of major hemorrhagic complications (6.6% per year) in the conventional intensity group (INR 2.2-3.5) than low intensity anticoagulation group (INR 1.5-2.1) (0% per year), although the annual ischemic stroke rate was low in both groups (1.1 % in the conventional group and 1.7 % in the low intensity group).…”

Section: Should a Lower Therapeutic Inr Range Be Considered For Some mentioning

confidence: 99%

Recent Progress in Antithrombotic Therapy for Atrial Fibrillation

Velu

Lip

2011

JAT

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Atrial fibrillation (AF) is becoming a major health care burden as elderly populations increase. The increased risk of stroke and thromboembolisms in patients with AF is well documented and anticoagulation with adjusted-dose warfarin is highly effective in reducing stroke risk, being superior to antiplatelet agents. Despite recognition of the epidemiological problem and the sound evidence base for thromboprophylaxis, as well as major guidelines recommending treatment, anticoagulation use is still suboptimal, given the dis-utility and limitations associated with warfarin.Recent developments in thromboprophylaxis for AF include efforts for better risk stratification for predictions of thromboembolic risk. Constant efforts are underway to develop newer, less cumbersome, alternatives to warfarin with similar (or better) efficacy. This review article provides an overview of the recent progress made, the potential challenges involved and the future of these therapeutic approaches.Atheroscler Thromb, 2011; 18:257-273.

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Optimal Intensity of International Normalized Ratio in Warfarin Therapy for Secondary Prevention of Stroke in Patients with Non-valvular Atrial Fibrillation.

Cited by 203 publications

References 15 publications

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

Acute Subdural Hematoma in Patients With Medication Associated With Risk of Hemorrhage

Recent Progress in Antithrombotic Therapy for Atrial Fibrillation

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