International normalized ratio control and subsequent clinical outcomes in patients with atrial fibrillation using warfarin

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Guimaraes, Patricia O.Duke Clin Res Inst, Durham, NC 27705 USA (author)

International normalized ratio control and subsequent clinical outcomes in patients with atrial fibrillation using warfarin

Article/chapterEnglish2019

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2019-04-10
Springer Science and Business Media LLC,2019
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LIBRIS-ID:oai:DiVA.org:uu-388767
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-388767URI
https://doi.org/10.1007/s11239-019-01858-1DOI

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Language:English
Summary in:English

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Subject category:art swepub-publicationtype

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We explored associations between INR measures and clinical outcomes in patients with AF using warfarin, and whether INR history predicted future INR measurements. We included patients in ARISTOTLE who were randomized to and received warfarin. Among patients who had events, we included those with ≥ 3 INR values in the 180 days prior to the event, with the most recent ≤ 60 days prior to the event, who were on warfarin at the time of event (n = 545). Non-event patients were included in the control group if they had ≥ 180 days of warfarin exposure with ≥ 3 INR measurements (n = 7259). The median (25th, 75th) number of INR values per patient was 29 (21, 38) over a median follow-up of 1.8 years. A total of 87% had at least one INR value < 1.5; 49% had at least one value > 4.0. The last INRs before events (median 14 [24, 7] days) were < 3.0 for at least 75% of patients with major bleeding and > 2.0 for half of patients with ischemic stroke. Historic time in therapeutic range (TTR) was weakly associated with future TTR (R2 = 0.212). Historic TTR ≥ 80% had limited predictive ability to discriminate future TTR ≥ 80% (C index 0.61). In patients with AF receiving warfarin, most bleeding events may not have been preventable despite careful INR control. Our findings suggest that INRs collected through routine management are not sufficiently predictive to provide reassurance about future time in therapeutic range or to prevent subsequent outcomes, and might be over-interpreted in clinical practice.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Hematologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Hematology hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
International normalized ratio
Clinical outcomes
Warfarin
Atrial fibrillation

Added entries (persons, corporate bodies, meetings, titles ...)

Lopes, Renato D.Duke Clin Res Inst, Durham, NC 27705 USA (author)
Alexander, John H.Duke Clin Res Inst, Durham, NC 27705 USA (author)
Thomas, LaineDuke Clin Res Inst, Durham, NC 27705 USA (author)
Hellkamp, Anne S.Duke Clin Res Inst, Durham, NC 27705 USA (author)
Hijazi, ZiadUppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi(Swepub:uu)ziahi940 (author)
Hylek, Elaine M.Boston Univ, Med Ctr, Boston, MA USA (author)
Gersh, Bernard J.Mayo Clin, Coll Med, Dept Cardiovasc Med, Rochester, MN USA (author)
Garcia, David A.Univ Washington, Sch Med, Med Ctr, Div Hematol,Dept Med, Seattle, WA 98195 USA (author)
Verheugt, Freek W. A.Hartctr OLVG, Afdeling Cardiol, Amsterdam, Netherlands (author)
Hanna, MichaelBristol Myers Squibb, Princeton, NJ USA (author)
Flaker, GregUniv Missouri, Sch Med, Columbia, MO USA (author)
Vinereanu, DragosUniv Med & Pharm Carol Davila, Bucharest, Romania (author)
Granger, Christopher B.Duke Clin Res Inst, Durham, NC 27705 USA (author)
Duke Clin Res Inst, Durham, NC 27705 USAUppsala kliniska forskningscentrum (UCR) (creator_code:org_t)

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In:Journal of Thrombosis and Thrombolysis: Springer Science and Business Media LLC48:1, s. 27-340929-53051573-742X

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By the author/editor: Guimaraes, Patri ...; Lopes, Renato D.; Alexander, John ...; Thomas, Laine; Hellkamp, Anne S ...; Hijazi, Ziad; show more...; Hylek, Elaine M.; Gersh, Bernard J ...; Garcia, David A.; Verheugt, Freek ...; Hanna, Michael; Flaker, Greg; Vinereanu, Drago ...; Granger, Christo ...; show less...

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