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Quality of Vitamin K Antagonist Control and 1-Year Outcomes in Patients with Atrial Fibrillation: A Global Perspective from the GARFIELD-AF Registry.

Haas, S; Ten Cate, H; Accetta, G; Angchaisuksiri, P; Bassand, J-P; Camm, AJ; Corbalan, R; Darius, H; Fitzmaurice, DA; Goldhaber, SZ; et al. Haas, S; Ten Cate, H; Accetta, G; Angchaisuksiri, P; Bassand, J-P; Camm, AJ; Corbalan, R; Darius, H; Fitzmaurice, DA; Goldhaber, SZ; Goto, S; Jacobson, B; Kayani, G; Mantovani, LG; Misselwitz, F; Pieper, K; Schellong, SM; Stepinska, J; Turpie, AGG; van Eickels, M; Kakkar, AK; GARFIELD-AF Investigators (2016) 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, 11 (10). ISSN 1932-6203 https://doi.org/10.1371/journal.pone.0164076
SGUL Authors: Camm, Alan John

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Abstract

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 VKA-treated 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. TRIAL REGISTRATION: ClinicalTrials.gov NCT01090362.

Item Type: Article
Additional Information: © 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.
Keywords: General Science & Technology, MD Multidisciplinary
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Cardiac (INCCCA)
Journal or Publication Title: PLoS One
Article Number: e0164076
ISSN: 1932-6203
Language: ENG
Dates:
DateEvent
28 October 2016Published
18 September 2016Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 27792741
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/108381
Publisher's version: https://doi.org/10.1371/journal.pone.0164076

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