Publication:
Quality of vitamin k antagonist control and 1-year outcomes in patients with atrial fibrillation: A global perspective from the GARFIELD-AF registry

Issued Date

2016-10-01

Resource Type

Article

ISSN

19326203

DOI

10.1371/journal.pone.0164076

Other identifier(s)

2-s2.0-84994045395

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

PLoS ONE. Vol.11, No.10 (2016)

Suggested Citation

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 Quality of vitamin k antagonist control and 1-year outcomes in patients with atrial fibrillation: A global perspective from the GARFIELD-AF registry. PLoS ONE. Vol.11, No.10 (2016). doi:10.1371/journal.pone.0164076 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/43354

Research Projects

Organizational Units

Authors

Journal Issue

Thesis

Title

Quality of vitamin k antagonist control and 1-year outcomes in patients with atrial fibrillation: A global perspective from the GARFIELD-AF registry

Author(s)

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

Other Contributor(s)

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
 UCL

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.

Keyword(s)

Agricultural and Biological Sciences
 Biochemistry, Genetics and Molecular Biology

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/43354

Collections

Scopus 2016-2017