Quality of vitamin K antagonist control and outcomes in atrial fibrillation patients: a meta-analysis and meta-regression

Mearns, Elizabeth S.; White, C Michael; Kohn, Christine G.; Hawthorne, Jessica; Song, Ju-Sung; Meng, Joy; Schein, Jeff; Raut, Monika; Coleman, Craig I.

doi:10.1186/1477-9560-12-14

Cited by 94 publications

(116 citation statements)

References 108 publications

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“…Thus, underanticoagulation is more frequent than overanticoagulation in this global registry. This confirms the conclusion from a previous meta-analysis and meta-regression on quality of VKA control and outcomes in patients with AF where patients on VKA were frequently outside the target INR range and tended to be underanticoagulated rather than overanticoagulated [14]. …”

Section: Discussionsupporting

confidence: 89%

Quality of Vitamin K Antagonist Control and 1-Year Outcomes in Patients with Atrial Fibrillation: A Global Perspective from the GARFIELD-AF Registry

Cate²,

et al. 2016

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AimsVitamin K antagonists (VKAs) need to be individually dosed. International guidelines recommend a target range of international normalised ratio (INR) of 2.0–3.0 for stroke prevention in atrial fibrillation (AF). We analysed the time in this therapeutic range (TTR) of VKA-treated patients with newly diagnosed AF in the ongoing, global, observational registry GARFIELD-AF. Taking TTR as a measure of the quality of patient management, we analysed its relationship with 1-year outcomes, including stroke/systemic embolism (SE), major bleeding, and all-cause mortality.Methods and ResultsTTR was calculated for 9934 patients using 136,082 INR measurements during 1-year follow-up. The mean TTR was 55.0%; values were similar for different VKAs. 5851 (58.9%) patients had TTR<65%; 4083 (41.1%) TTR≥65%. The proportion of patients with TTR≥65% varied from 16.7% in Asia to 49.4% in Europe. There was a 2.6-fold increase in the risk of stroke/SE, 1.5-fold increase in the risk of major bleeding, and 2.4-fold increase in the risk of all-cause mortality with TTR<65% versus ≥65% after adjusting for potential confounders. The population attributable fraction, i.e. the proportion of events attributable to suboptimal anticoagulation among VKA users, was 47.7% for stroke/SE, 16.7% for major bleeding, and 45.4% for all-cause mortality. In patients with TTR<65%, the risk of first stroke/SE was highest in the first 4 months and decreased thereafter (test for trend, p = 0.021). In these patients, the risk of first major bleed declined during follow-up (p = 0.005), whereas in patients with TTR≥65%, the risk increased over time (p = 0.027).ConclusionA large proportion of patients with AF had poor VKA control and these patients had higher risks of stroke/SE, major bleeding, and all-cause mortality. Our data suggest that there is room for improvement of VKA control in routine clinical practice and that this could substantially reduce adverse outcomes.Trial RegistrationClinicalTrials.gov NCT01090362

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Section: Discussionsupporting

confidence: 89%

Quality of Vitamin K Antagonist Control and 1-Year Outcomes in Patients with Atrial Fibrillation: A Global Perspective from the GARFIELD-AF Registry

Cate²,

et al. 2016

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“…Meta‐analyses of warfarin‐treated AF patients demonstrated 56% of measured INR to be within range and a TTR of 61% . Our study demonstrated superior control, with 73% of measured INR in the range of 2.0–3.0 and a mean TTR of 81%.…”

Section: Discussionmentioning

confidence: 54%

Quality of warfarin control in atrial fibrillation patients in South East Queensland, Australia

Bernaitis

Badrick

Davey

et al. 2016

Internal Medicine Journal

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“…Por ello, la informació n del estudio PAULA ofrece datos de gran interé s. En el estudio PAULA, el 43,1% de los pacientes tenían en rango terapé utico menos del 60% de los controles realizados en el ú ltimo añ o y el 39,4% mostró un tiempo en rango terapé utico < 65%, con una media de 14,4 determinaciones por paciente. En un metaná lisis de 95 artículos, los pacientes anticoagulados con AVK se mantuvieron el 61% del tiempo en rango terapé utico, y fue mejor el control observado en ensayos clínicos o en clínicas especializadas que en otros escenarios 31 . Por lo tanto, se puede decir que el control de la anticoagulació n en Españ a es malo, algo similar a lo que ocurre en otros países.…”

Section: Discusió Nunclassified

Control de la anticoagulación en pacientes con fibrilación auricular no valvular asistidos en atención primaria en España. Estudio PAULA

Barrios

Escobar

Prieto

et al. 2015

Revista Española de Cardiología

124

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Quality of vitamin K antagonist control and outcomes in atrial fibrillation patients: a meta-analysis and meta-regression

Cited by 94 publications

References 108 publications

Quality of Vitamin K Antagonist Control and 1-Year Outcomes in Patients with Atrial Fibrillation: A Global Perspective from the GARFIELD-AF Registry

Quality of Vitamin K Antagonist Control and 1-Year Outcomes in Patients with Atrial Fibrillation: A Global Perspective from the GARFIELD-AF Registry

Quality of warfarin control in atrial fibrillation patients in South East Queensland, Australia

Control de la anticoagulación en pacientes con fibrilación auricular no valvular asistidos en atención primaria en España. Estudio PAULA

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