Poor Time in Therapeutic Range Control is Associated with Adverse Clinical Outcomes in Patients with Non-Valvular Atrial Fibrillation: A Report from the Nationwide COOL-AF Registry



Krittayaphong, Rungroj, Chantrarat, Thoranis, Rojjarekampai, Roj, Jittham, Pongpun, Sairat, Poom and Lip, Gregory YH ORCID: 0000-0002-7566-1626
(2020) Poor Time in Therapeutic Range Control is Associated with Adverse Clinical Outcomes in Patients with Non-Valvular Atrial Fibrillation: A Report from the Nationwide COOL-AF Registry. JOURNAL OF CLINICAL MEDICINE, 9 (6). E1698-.

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Abstract

<h4>Background</h4>Warfarin remains the most commonly used oral anticoagulant (OAC) in Thailand for stroke prevention among patients with non-valvular atrial fibrillation (NVAF). The aim of this study was to investigate the relationship between time in therapeutic range (TTR) after warfarin initiation and clinical outcomes of NVAF.<h4>Methods</h4>TTR was calculated by the Rosendaal method from international normalized ratio (INR) data acquired from a nationwide NVAF registry in Thailand. Patients were followed-up every six months. The association between TTR and clinical outcomes was analyzed.<h4>Results</h4>There was a total of 2233 patients from 27 hospitals. The average age was 68.4 ± 10.6 years. The average TTR was 53.56 ± 26.37%. Rates of ischemic stroke/TIA, major bleeding, ICH, and death were 1.33, 2.48, 0.76, and 3.3 per 100 person-years, respectively. When patients with a TTR < 65% were compared with those with TTR ≥ 65%, the adjusted hazard ratios (aHR) for the increased risks of ischemic stroke/TIA, major bleeding, ICH, and death were 3.07, 1.90, 2.34, and 2.11, respectively.<h4>Conclusion</h4>Poor TTR control is associated with adverse clinical outcomes in patients with NVAF who were on warfarin. Efforts to ensure good TTR (≥65%) after initiation of warfarin are mandatory to minimize the risk of adverse clinical outcomes.

Item Type: Article
Uncontrolled Keywords: atrial fibrillation, warfarin, time in therapeutic range, TTR, outcomes
Depositing User: Symplectic Admin
Date Deposited: 26 Aug 2020 10:42
Last Modified: 29 Mar 2023 08:24
DOI: 10.3390/jcm9061698
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3098783