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Outcomes Among Patients With Atrial Fibrillation and Appropriate Anticoagulation Control

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@article{231aa8a69562420aa689f1fd1b3f2461,
title = "Outcomes Among Patients With Atrial Fibrillation and Appropriate Anticoagulation Control",
abstract = "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.",
author = "Bonde, {Anders Nissen} and Laila Staerk and Lee, {Christina J-Y} and Vinding, {Naja Emborg} and Bang, {Casper N} and Christian Torp-Pedersen and Gunnar Gislason and Lip, {Gregory Y H} and Olesen, {Jonas Bjerring}",
note = "Copyright {\circledC} 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.",
year = "2018",
month = "9",
day = "18",
doi = "10.1016/j.jacc.2018.06.065",
language = "English",
volume = "72",
pages = "1357--1365",
journal = "American College of Cardiology. Journal",
issn = "0735-1097",
publisher = "Elsevier Inc",
number = "12",

}

RIS

TY - JOUR

T1 - Outcomes Among Patients With Atrial Fibrillation and Appropriate Anticoagulation Control

AU - Bonde, Anders Nissen

AU - Staerk, Laila

AU - Lee, Christina J-Y

AU - Vinding, Naja Emborg

AU - Bang, Casper N

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar

AU - Lip, Gregory Y H

AU - Olesen, Jonas Bjerring

N1 - Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PY - 2018/9/18

Y1 - 2018/9/18

N2 - 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.

AB - 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.

U2 - 10.1016/j.jacc.2018.06.065

DO - 10.1016/j.jacc.2018.06.065

M3 - Journal article

VL - 72

SP - 1357

EP - 1365

JO - American College of Cardiology. Journal

JF - American College of Cardiology. Journal

SN - 0735-1097

IS - 12

ER -

ID: 55203507