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Title: Quality of vitamin k antagonist control and 1-year outcomes in patients with atrial fibrillation: A global perspective from the GARFIELD-AF registry
Authors: Sylvia Haas
Hugo Ten Cate
Gabriele Accetta
Pantep Angchaisuksiri
Jean Pierre Bassand
A. John Camm
Ramon Corbalan
Harald Darius
David A. Fitzmaurice
Samuel Z. Goldhaber
Shinya Goto
Barry Jacobson
Gloria Kayani
Lorenzo G. Mantovani
Frank Misselwitz
Karen Pieper
Sebastian M. Schellong
Janina Stepinska
Alexander G.G. Turpie
Martin Van Eickels
Ajay K. Kakkar
University Hospital Rechts der Isar
Cardiovascular Research Institute Maastricht
Thrombosis Research Institute
Mahidol University
Universite de Franche-Comte
St George's University of London
Pontificia Universidad Católica de Chile
Vivantes Neukoelln Medical Center
University of Birmingham
Brigham and Women's Hospital
Tokai University School of Medicine
Johannesburg Hospital
University of Milano - Bicocca
Bayer Pharma AG
Duke Clinical Research Institute
Krankenhaus Dresden-Friedrichstadt
Instytut Kardiologii im. Prymasa Tysiaclecia Stefana Kardynała Wyszynskiego
McMaster University, Faculty of Health Sciences
Keywords: Agricultural and Biological Sciences;Biochemistry, Genetics and Molecular Biology
Issue Date: 1-Oct-2016
Citation: PLoS ONE. Vol.11, No.10 (2016)
Abstract: © 2016 Haas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Aims Vitamin K antagonists (VKAs) need to be individually dosed. International guidelines recommend a target range of international normalised ratio (INR) of 2.0-3.0 for stroke prevention in atrial fibrillation (AF). We analysed the time in this therapeutic range (TTR) of VKAtreated patients with newly diagnosed AF in the ongoing, global, observational registry GARFIELD-AF. Taking TTR as a measure of the quality of patient management, we analysed its relationship with 1-year outcomes, including stroke/systemic embolism (SE), major bleeding, and all-cause mortality. Methods and Results TTR was calculated for 9934 patients using 136,082 INR measurements during 1-year follow-up. The mean TTR was 55.0%; values were similar for different VKAs. 5851 (58.9%) patients had TTR<65%; 4083 (41.1%) TTR≥65%. The proportion of patients with TTR≥65% varied from 16.7% in Asia to 49.4% in Europe. There was a 2.6-fold increase in the risk of stroke/SE, 1.5-fold increase in the risk of major bleeding, and 2.4-fold increase in the risk of all-cause mortality with TTR<65% versus ≥65% after adjusting for potential confounders. The population attributable fraction, i.e. the proportion of events attributable to suboptimal anticoagulation among VKA users, was 47.7% for stroke/SE, 16.7% for major bleeding, and 45.4% for all-cause mortality. In patients with TTR<65%, the risk of first stroke/SE was highest in the first 4 months and decreased thereafter (test for trend, p = 0.021). In these patients, the risk of first major bleed declined during follow-up (p = 0.005), whereas in patients with TTR≥65%, the risk increased over time (p = 0.027). Conclusion A large proportion of patients with AF had poor VKA control and these patients had higher risks of stroke/SE, major bleeding, and all-cause mortality. Our data suggest that there is room for improvement of VKA control in routine clinical practice and that this could substantially reduce adverse outcomes.
ISSN: 19326203
Appears in Collections:Scopus 2016-2017

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