Anticoagulation Control in Older Atrial Fibrillation Patients Receiving Vitamin K Antagonist Therapy for Stroke Prevention

Zulkifly, Hanis, Lip, Gregory YH ORCID: 0000-0002-7566-1626 and Lane, Deirdre A ORCID: 0000-0002-5604-9378 (2022) Anticoagulation Control in Older Atrial Fibrillation Patients Receiving Vitamin K Antagonist Therapy for Stroke Prevention. INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, 2022. 5951262-.

Access the full-text of this item by clicking on the Open Access link.

Official URL: http://dx.doi.org/10.1155/2022/5951262

Abstract

<h4>Introduction</h4>Efficacy and safety of vitamin K antagonists (VKAs) among atrial fibrillation (AF) patients are enhanced when the International Normalised Ratio (INR) is 2.0-3.0. Anticoagulation control among older patients is perceived to be lower and contributes to poorer initiation and uptake.<h4>Objective</h4>To examine the quality of INR control, adverse clinical outcomes, and factors associated with bleeding in older AF patients (≥80 years).<h4>Methods</h4>Anticoagulation control assessed by time in therapeutic range (TTR) (Rosendaal method) and percentage INRs in range (PINRR). Among the 205 patients aged ≥80 years, 58.5% were female, with mean (SD) CHA<sub>2</sub>DS<sub>2</sub>-VASc 4.4 (1.3) and HAS-BLED 1.8 (0.8) scores.<h4>Results</h4>Mean (SD) TTR and PINRR were similar for those aged ≥80 vs. <80 years (66.7 (13.8) vs. 66.7 (13.1)) despite significantly lower INR monitoring intensity (51.2 (22.7) vs. 60.7 (25.8)) and shorter follow-up (4.4 (2.6-6.2) vs. 5.7 years (3.3-7.1)) in those ≥80 years of age. Good anticoagulation control (TTR and PINRR ≥70%) of 44% was seen in both age groups. No significant differences in composite major adverse clinical events were evident for those aged ≥80 vs. <80 years (<i>p</i> = 0.55). Cox regression analysis confirmed that age ≥80 years was associated with higher risk of bleeding (HR 1.90 (1.01-3.56); <i>p</i> = 0.047).<h4>Conclusions</h4>Suboptimal (TTR and PINRR <70%) anticoagulation control was evident in all patients. Risk of bleeding increased, but there was no difference in thromboembolic events and all-cause mortality in those aged ≥80 years. Improving TTR to ≥70% and enhancing anticoagulation monitoring of VKA use remain a clinical priority to prevent bleeding complications, particularly among those aged 80 years and above.

Item Type:	Article
Uncontrolled Keywords:	Humans, Atrial Fibrillation, Hemorrhage, Vitamin K, Fibrinolytic Agents, Anticoagulants, International Normalized Ratio, Aged, Aged, 80 and over, Female, Male, Stroke
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	05 May 2022 15:18
Last Modified:	18 Jan 2023 21:04
DOI:	10.1155/2022/5951262
Open Access URL:	https://www.hindawi.com/journals/ijclp/2022/595126...
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3154338