Outcomes Among Patients With Atrial Fibrillation and Appropriate Anticoagulation Control

Anders Nissen Bonde, Laila Staerk, Christina J-Y Lee, Naja Emborg Vinding, Casper N Bang, Christian Torp-Pedersen, Gunnar Gislason, Gregory Y H Lip, Jonas Bjerring Olesen

Publikation: Bidrag til tidsskriftArtikelForskningpeer review


BACKGROUND: 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.

OBJECTIVES: This study sought to assess future TTR and risk of stroke/thromboembolism and major bleeding among AF patients on VKA with TTR ?70%.

METHODS: 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.

RESULTS: 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 authors estimated TTR time-dependently during follow-up, TTR <70% was associated with an increased risk of stroke/thromboembolism (HR: 1.91; 95% CI: 1.30 to 2.82) and major bleeding (HR: 1.34; 95% CI: 1.02 to 1.76).

CONCLUSIONS: Among AF patients on VKA, almost one-half of patients with prior TTR ?70% had TTR <70% during the following year. Prior TTR ?70% per se had limited long-term prognostic value.

Sider (fra-til)1357-1365
Antal sider9
TidsskriftJournal of the American College of Cardiology
Udgave nummer12
StatusUdgivet - 18 sep. 2018

Bibliografisk note

Copyright � 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.


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