Abstract
BACKGROUND: Optimal time in therapeutic range (TTR) of vitamin K antagonists (VKAs) is crucial for cardiovascular events (CVEs) prevention in non-valvular atrial fibrillation (NVAF). The relationship between temporal changes of TTR and the incidence of CVEs has been poorly investigated. We investigated 1) temporal trends of TTR in a long-term follow-up of NVAF patients; 2) the incidence of CVEs according to changes of TTR.
METHODS: Prospective observational study including 1341 NVAF outpatients (mean age 73.5 years, 42.5% male) starting VKAs. Patients were divided into 4 groups: Group 0: Optimal TTR, consistently ≥70% (n = 241); Group 1: Temporally worsening TTR, from above to below 70% (n = 263); Group 2: Temporally improving TTR, from below to above 70% (n = 270); Group 3: Suboptimal TTR, consistently <70% (n = 567).
RESULTS: In a mean follow-up of 37.7 months (4214.2 patient-years), 108 CVEs occurred (2.6%/year). Survival analysis showed a graded increased risk of CVEs in relation to temporal changes in TTR, with the worst outcomes in Groups 1 and 3 (log-rank test p = 0.013). Multivariable Cox proportional hazards regression analysis showed that Group 1 vs. 0 (HR: 2.096; 95%CI 1.061-4.139, p = 0.033), Group 3 vs. 0 (HR: 2.292; 95%CI 1.205-4.361, p = 0.011), CHA2DS2VASc score (HR:1.316; 95%CI 1.153-1.501, p < 0.001) and PPIs (HR:0.453; 95%CI 0.285-0.721, p = 0.001) were independently associated with CVEs.
CONCLUSION: A decrease of TTR <70% over time is observed in almost 20% of NVAF patients. Patients with worsening TTR temporally (ie. from initially above 70% to below 70%) have similar risk of CVEs of patients with consistently suboptimal anticoagulation.
Original language | English |
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Journal | European Journal of Internal Medicine |
Volume | 54 |
Pages (from-to) | 34-39 |
Number of pages | 6 |
ISSN | 0953-6205 |
DOIs | |
Publication status | Published - Aug 2018 |
Bibliographical note
Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.Keywords
- Aged
- Aged, 80 and over
- Anticoagulants/therapeutic use
- Atrial Fibrillation/drug therapy
- Female
- Hemorrhage/epidemiology
- Humans
- Incidence
- International Normalized Ratio
- Italy/epidemiology
- Male
- Middle Aged
- Multivariate Analysis
- Proportional Hazards Models
- Prospective Studies
- Risk Assessment/methods
- Risk Factors
- Stroke/epidemiology
- Time Factors
- Treatment Outcome
- Vitamin K/antagonists & inhibitors