Relationship between the nutritional status and safety and efficacy outcomes in atrial fibrillation patients aged 80 years and over receiving oral anticoagulants

Shinohara, Mie; Wada, Ryo; Yano, Kensuke; Akitsu, Katsuya; Koike, Hideki; Kinoshita, Toshio; Fujino, Tadashi; Ikeda, Takanori

doi:10.1016/j.jjcc.2020.10.008

Cited by 8 publications

(2 citation statements)

References 24 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 16 Notably, patients in Asian UMICs tend to have poor baseline nutritional status, low body weight, and an increased risk of bleeding when exposed to anticoagulants. 17 , 18 These differences, combined with differences in health care systems, can lead to divergent treatment outcomes between UMICs and HICs. 16 This multicenter cohort study in Thailand aims to assess trends in anticoagulant regimens and their clinical outcomes within an UMIC context.…”

Section: Introductionmentioning

confidence: 99%

Trends in Anticoagulant Utilization and Clinical Outcomes for Cancer-Associated Thrombosis: A Multicenter Cohort Study in Thailand's Upper-Middle–Income Country Setting

Kengkla,

Nathisuwan,

Sripakdee

et al. 2024

JCO Glob Oncol

View full text Add to dashboard Cite

PURPOSE To evaluate anticoagulant trends and clinical outcomes in the management of cancer-associated thrombosis (CAT) within Thailand, an upper-middle–income country (UMIC). METHODS This multicenter retrospective cohort study included adult patients with cancer diagnosed with venous thromboembolism (VTE) hospitalized in Thailand from 2017 to 2021. Anticoagulants were classified as low-molecular-weight heparin (LMWH), direct oral anticoagulants (DOACs), and warfarin. Prescription trends were assessed, and patients were followed for 1 year, or until 2022 to evaluate outcomes. The primary effectiveness outcome was recurrent VTE, whereas the primary safety outcome was major bleeding. Secondary outcomes included net clinical benefit and all-cause mortality. Treatment effects were examined using inverse probability of treatment weighting (IPTW) Cox proportional hazards models. RESULTS Among 1,611 patients (61.3% female; mean age, 58.8 years; standard deviation, 13.1 years), 86% received LMWH, 10% warfarin, and 4% DOACs. In the study cohort, LMWH prescriptions remained consistent, warfarin use declined, and DOAC prescriptions notably increased. In IPTW analysis, DOACs showed comparable rates of VTE recurrence (weighted hazard ratio [HR], 0.77 [95% CI, 0.22 to 2.70]; P = .679) and major bleeding (weighted HR, 0.62 [95% CI, 0.15 to 2.55]; P = .506) with LMWH. Warfarin had a higher risk of major bleeding (weighted HR, 2.74 [95% CI, 1.12 to 6.72]; P = .028) but a similar rate of VTE recurrence (weighted HR, 1.46 [95% CI, 0.75 to 2.84]; P = .271) compared with LMWH. Secondary outcomes were consistent across groups. CONCLUSION LMWH remains the primary treatment for CAT, in line with current guidelines. The study highlights the challenges faced in these settings with the continuous use of warfarin. The comparable efficacy and safety of DOACs with LMWH suggest a potential shift in CAT management within UMICs.

show abstract

Section: Introductionmentioning

confidence: 99%

Trends in Anticoagulant Utilization and Clinical Outcomes for Cancer-Associated Thrombosis: A Multicenter Cohort Study in Thailand's Upper-Middle–Income Country Setting

Kengkla,

Nathisuwan,

Sripakdee

et al. 2024

JCO Glob Oncol

View full text Add to dashboard Cite

show abstract

“…Patients with malnutrition are more likely to develop AF 10 . In addition, several recent studies showed that malnutrition was significantly associated with cardiovascular events, recurrence of AF after catheter ablation, and all-cause mortality 11 , 12 .…”

Section: Introductionmentioning

confidence: 99%

Low alanine aminotransferase levels are independently associated with mortality risk in patients with atrial fibrillation

Saito

Okumura

Nagashima

et al. 2022

Sci Rep

View full text Add to dashboard Cite

Extremely low alanine aminotransferase (ALT) may reflect aging, frailty, sarcopenia, and malnutrition in several cardiovascular diseases, but the association between low ALT and patient characteristics, cardiovascular and all-cause mortality is not well investigated in the population with atrial fibrillation. We conducted a post hoc analysis of a prospective, observational multicenter study. Patients with nonvalvular AF in the SAKURA AF Registry (n = 3156) were classified into 3 tertiles according to baseline ALT: first (ALT ≤ 15 U/L, n = 1098), second (15 < ALT < 23 U/L, n = 1055), and third (ALT ≥ 23 U/L, n = 1003). The first tertile had an older age; lower body mass index (BMI); higher prevalence of heart failure; and lower hemoglobin, total cholesterol, and triglycerides (all P < 0.05). During median 39.2 months follow-up, the first tertile had significantly higher incidences of cardiovascular and all-cause mortality (log-rank P < 0.001). Lower ALT was significantly associated with the incidence of cardiovascular and all-cause mortality, even after adjusting for clinically relevant factors (P < 0.05). Low ALT may reflect aging, sarcopenia, and malnutrition and be independently associated with a high risk of all-cause mortality in patients with AF.

show abstract

Lymphocyte‐to‐C‐reactive protein ratio and score in patients with heart failure: Nutritional status, physical function, and prognosis

Maeda,

Matsue,

Kagiyama

et al. 2024

ESC Heart Failure

View full text Add to dashboard Cite

AimsIn heart failure (HF), inflammation is linked to malnutrition and impaired physical function. In this study, we aimed to assess how novel nutritional–inflammatory markers and lymphocyte‐to‐C‐reactive protein ratio (LCR) and score (LCS) are associated with the nutritional status, physical function, and prognosis of patients with HF.Methods and resultsThis study was a secondary analysis of the FRAGILE‐HF study, a prospective observational study conducted across 15 hospitals in Japan. We included 1212 patients (mean age, 80.2 ± 7.8 years; 513 women) hospitalized with HF, who were classified into three groups according to their LCS score: 0 (n = 498), 1 (n = 533), and 2 (n = 181). Baseline data on physical examination, echocardiography, blood test results (including lymphocyte counts and CRP levels), and oral medication usage were collected in a clinically compensated state before discharge. Nutritional status and physical function were evaluated using several indices and tests. The primary outcome of this study was all‐cause death within 2 years. Univariate and multivariate linear regression analyses were performed to evaluate the associations among the nutritional status, physical function, and LCR/LCS. Patients with an LCS score of 2 were older and had a lower body mass index than those in the other two groups. Multivariate linear regression analysis revealed that lower LCR and higher LCS were independently associated with worse nutritional status, lower handgrip strength, shorter physical performance battery score, and shorter 6‐min walk distance. At 2 years, all‐cause death occurred in 254 patients: 86 (17.6%), 113 (21.5%), and 55 (30.9%) with LCS scores of 0, 1, and 2, respectively (P = 0.001). Cox proportional hazards analysis revealed that LCR and LCS were significantly associated with 2‐year mortality even after adjusting for the conventional risk model (LCS score, 0 vs. 2: hazard ratio, 1.64; 95% confidence interval [CI]; 1.14–2.35; P = 0.007; log‐transformed LCR: hazard ratio, 0.88; 95% CI, 0.81–0.95; P = 0.002). LCR yielded additional prognostic predictability compared with the conventional risk model (continuous net reclassification improvement, 0.153; 95% CI, 0.007–0.299; P = 0.041).ConclusionsLCR and LCS emerge as potential predictors of nutritional status, physical function, and prognosis in older patients with HF.

show abstract

Relationship between the nutritional status and safety and efficacy outcomes in atrial fibrillation patients aged 80 years and over receiving oral anticoagulants

Cited by 8 publications

References 24 publications

Trends in Anticoagulant Utilization and Clinical Outcomes for Cancer-Associated Thrombosis: A Multicenter Cohort Study in Thailand's Upper-Middle–Income Country Setting

Trends in Anticoagulant Utilization and Clinical Outcomes for Cancer-Associated Thrombosis: A Multicenter Cohort Study in Thailand's Upper-Middle–Income Country Setting

Low alanine aminotransferase levels are independently associated with mortality risk in patients with atrial fibrillation

Lymphocyte‐to‐C‐reactive protein ratio and score in patients with heart failure: Nutritional status, physical function, and prognosis

Contact Info

Product

Resources

About