Outcomes Among Patients With Atrial Fibrillation and Appropriate Anticoagulation Control

Journal of the American College of Cardiology
Anders Nissen BondeJonas Bjerring Olesen

Abstract

Atrial fibrillation (AF) patients on a vitamin K antagonist (VKA) with time in therapeutic range (TTR) ≥70% are not recommended to switch to a direct oral anticoagulant according to guidelines. This study sought to assess future TTR and risk of stroke/thromboembolism and major bleeding among AF patients on VKA with TTR ≥70%. The authors used Danish nationwide registries to identify AF patients on VKA from 1997 to 2011 with available international normalized ratio values. Patients were included 6 months after VKA initiation, divided according to TTR, and followed for 12 months after inclusion. Cox proportional hazard models estimated hazard ratios (HRs). TTR was examined both as a baseline variable and as a time-dependent covariate in the Cox models. Of the 4,772 included AF patients still on VKA 6 months after initiation, 1,691 (35.4%) had a TTR ≥70%, and 3,081 (65.6%) had a TTR <70%. Among patients with prior TTR ≥70% still on treatment 12 months after inclusion, only 513 (55.7%) still had a TTR ≥70%. Compared with prior TTR ≥70%, prior TTR <70% was not associated with a higher risk of stroke/thromboembolism (HR: 1.14; 95% confidence interval [CI]: 0.77 to 1.70) or major bleeding (HR: 1.12; 95% CI: 0.84 to 1.49). When the auth...Continue Reading

Citations

Apr 15, 2020·Circulation. Cardiovascular Quality and Outcomes·Anders N BondeMark A Hlatky
May 7, 2020·Journal of the American Heart Association·Xiaoxi YaoPeter A Noseworthy
Mar 28, 2019·Frontiers in Cardiovascular Medicine·Daniele PastoriFrancesco Violi
Jun 18, 2020·Research and Practice in Thrombosis and Haemostasis·Jasper H A van MiertKarina Meijer
Feb 23, 2020·British Journal of Haematology·Daniele PastoriUNKNOWN Italian Federation of Anticoagulation Clinics (FCSA)
Feb 4, 2021·International Journal of Clinical Practice·Daniele PastoriUNKNOWN Italian Federation of Anticoagulation Clinics (FCSA)

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