Comparison of the Abilities of Summary Measures of International Normalized Ratio Control to Predict Clinically Relevant Bleeding

Circulation. Cardiovascular Quality and Outcomes
A J RoseDaniel M Witt

Abstract

Limited research has compared the measures of summarizing international normalized ratio (INR) control over time. Measures that are more predictive of patient outcomes would be preferred as would those that are easier to calculate and understand. We examined 676 patients who received long-term warfarin therapy to treat atrial fibrillation: 125 patients who experienced major hemorrhage and 551 matched controls who did not. Patient INR control was characterized using various measures, from simple (proportion of INR values in range) to complex (eg, area under the curve above target range, squared) measures. Conditional logistic regression was used to examine the ability of each measure to predict the outcome of clinically relevant bleeding across quintiles of control. All measures were associated with clinically relevant bleeding to some extent: patients with the poorest control had significantly more bleeding events compared with patients with the best control. The measure most strongly associated with bleeding was a combination of percent time in therapeutic range and INR variability (odds ratio of 4.34, comparing the lowest to the highest quintiles of control). The strongest single predictor was INR variability, followed closel...Continue Reading

References

Sep 26, 1996·The New England Journal of Medicine·R H BrookP D Cleary
Jun 13, 2001·JAMA : the Journal of the American Medical Association·B F GageM J Radford
Mar 31, 2009·Joint Commission Journal on Quality and Patient Safety·Adam J RoseElaine M Hylek
Feb 18, 2011·Journal of Thrombosis and Thrombolysis·Daniel M Witt
Jun 30, 2011·Circulation. Cardiovascular Quality and Outcomes·Adam J RoseJeremy D Goldhaber-Fiebert
Nov 20, 2013·Journal of General Internal Medicine·Adam J Rose

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Citations

Jul 26, 2018·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Barbora KorpallováMarián Mokáň
Oct 14, 2017·Journal of the American Heart Association·Brent A WilliamsPeter B Berger
Oct 7, 2017·Journal of the American Heart Association·Kueiyu Joshua LinSebastian Schneeweiss
Jun 19, 2019·Seminars in Dialysis·Robert F Reilly, Nishank Jain

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