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Time in therapeutic...
Time in therapeutic range and outcomes after warfarin initiation in newly diagnosed atrial fibrillation patients with renal dysfunction
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Szummer, Karolina (författare)
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Gasparini, Alessandro (författare)
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Eliasson, Staffan (författare)
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visa fler...
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Ärnlöv, Johan (författare)
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Qureshi, Abdul Rashid (författare)
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Bárány, Peter (författare)
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Evans, Marie (författare)
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Friberg, Leif (författare)
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Carrero, Juan Jesus (författare)
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visa färre...
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(utgivare)
- 2017
- 2017
- Engelska.
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Ingår i: Journal of the American Heart Association. - 2047-9980. ; 6:3
Abstract
Ämnesord
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- BACKGROUND: It is unknown whether renal dysfunction conveys poor anticoagulation control in warfarin-treated patients with atrial fibrillation and whether poor anticoagulation control associates with the risk of adverse outcomes in these patients. METHODS AND RESULTS: This was an observational study from the Stockholm CREatinine Measurements (SCREAM) cohort including all newly diagnosed atrial fibrillation patients initiating treatment with warfarin (n=7738) in Stockholm, Sweden, between 2006 and 2011. Estimated glomerular filtration rate (eGFR; mL/min per 1.73 m(2)) was calculated from serum creatinine. Time-in-therapeutic range (TTR) was assessed from international normalized ratio (INR) measurements up to warfarin cessation, adverse event, or end of follow-up (2 years). Adverse events considered a composite of intracranial hemorrhage, ischemic stroke, myocardial infarction, or death. During median 254 days, TTR was 83%, based on median 21 INR measurements per patient. TTR was 70% among patients with eGFR <30, around 10% lower than in those with normal renal function. During observation, adverse events occurred in 4.0% of patients, and those with TTR ≤75% were at higher adverse event risk. This was independent of patient characteristics, comorbidities, number of INR tests, days exposed to warfarin, and, notably, independent of eGFR: adjusted odds ratio (OR) 1.84 (95% CI, 1.41-2.40) for TTR 75% to 60% and adjusted OR 2.09 (1.59-2.74) for TTR <60%. No interaction was observed between eGFR and TTR in association to adverse events (P=0.2). CONCLUSION: Severe chronic kidney disease (eGFR <30) patients with atrial fibrillation have worse INR control while on warfarin. An optimal TTR (>75%) is associated with lower risk of adverse events, independently of underlying renal function.
Ämnesord
- Medical and Health Sciences (hsv)
- Clinical Medicine (hsv)
- Medicin och hälsovetenskap (hsv)
- Klinisk medicin (hsv)
- Health and Welfare (du)
- Hälsa och välfärd (du)
Nyckelord
- all‐cause death
- anticoagulant
- atrial fibrillation
- bleeding
- ischemic stroke
- renal function
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