Anticoagulation control in Sweden: reports of time in therapeutic range, major bleeding, and thrombo-embolic complications from the national quality registry AuriculA

Wieloch, Mattias; Själander, Anders; Frykman, Viveka; Rosenqvist, Mårten; Eriksson, Niclas; Svensson, Peter

doi:10.1093/eurheartj/ehr134

Cited by 221 publications

(173 citation statements)

References 14 publications

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“…The findings that women's responses to AC treatment were better than those of men among patients with CE were previously reported (Laupacis et al., 1994). It is not likely to assume that differences from therapeutic INR 2–3 will explain these differences (Wieloch et al., 2011). Many recurrences with unchanged treatment occurring of one and the same patient is of great importance for the interpretation of results.…”

Section: Discussionmentioning

confidence: 99%

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

Eriksson

2016

Brain and Behavior

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ObjectivesTo assess long‐term prognosis after transient ischemic attack (TIA)/subtypes of stroke relative to secondary prophylactic treatment(s) given.Materials and MethodsRetro/prospective follow‐up of patients hospitalized in the Stroke Unit or in the Department of Neurology, Linköping, in 1986 and followed up to Feb. 2011.ResultsA total of 288 men were followed up for 2254 years (mean 7.8 years) and 261 women for 1984 years (mean 7.6 years). In men, the distribution to anticoagulants (AC) (warfarin treatment) was 18%, antiplatelet therapy (APT) usually ASA 75 mg/day 54%, untreated 27%, unknown 2%. In women, the distribution to AC was 15%, APT 60%, untreated 23%, unknown 2%, respectively. Mortality rates at 1 year, 10 years, and 25 years for men were 21%, 67%, and 93%, respectively, versus the rates in women of 24%, 71%, and 90%, respectively. Survival curves showed markedly increased risk of death compared to the normal population. AC treatment was more favorable for men regarding the annual risk of stroke, compared with APT (9.4% vs. 9.8%), as well as the risks of MI, (5.6% vs. 6.7%), and death (8.1% vs. 10.3%), compared to women for stroke (11.6% vs. 8.8%) and MI (5.3% vs. 3.7%) but not for death (8.3% vs. 8.4%). The risk of fatal bleeding was 0.86% annually on AC compared to 0.17% on APT. According to Cox regression analysis included patients with TIA/ischemic stroke, first‐line treatment had beneficial effects on survival: AC OR 0.67 (0.5–0.9), APT 0.67 (0.52–0.88) versus untreated.ConclusionsPatients with a history of TIA/stroke had a higher mortality rate versus controls, providing support for both primary and secondary prophylaxis regarding vascular risk factors for death. This study also provided support for secondary prophylactic treatment with either AC or ASA (75 mg once daily) to reduce the vascular risk of death unless there are contraindications.

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Section: Discussionmentioning

confidence: 99%

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

Eriksson

2016

Brain and Behavior

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“…4,5 Although rates of major hemorrhage reported in trials of warfarin therapy typically range between 1% and 3% per person-year, [6][7][8][9][10][11] observational studies suggest that rates may be considerably higher when warfarin is prescribed outside of a clinical trial setting, [12][13][14][15] approaching 7% per person-year in some studies. [13][14][15] The different safety profiles derived from clinical trials and observational data may reflect the careful selection of patients, precise definitions of bleeding and close monitoring in the trial setting.…”

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confidence: 99%

Rates of hemorrhage during warfarin therapy for atrial fibrillation

Gomes

Mamdani

Holbrook

et al. 2012

CMAJ

175

126

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Interpretation:In this large cohort of older patients with atrial fibrillation, we found that rates of hemorrhage are highest within the first 30 days of warfarin therapy. These rates are considerably higher than the rates of 1%-3% reported in randomized controlled trials of warfarin therapy. Our study provides timely estimates of warfarin-related adverse events that may be useful to clinicians, patients and policy-makers as new options for treatment become available. Abstract

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“…Our results are confirmed by previous studies which showed warfarin's INR stability is independently linked to age 32 . While other studies found a significant association between stability and age 33 . There are differences related to anticoagulants efficacy, especially among women, as it was found that female gender significantly spend more time outside the INR therapeutic range than men, as shown in a recently published study, 29% of women where below the INR therapeutic range versus 26% of men, by this putting them at a more risk of ischemic stroke 34 .…”

Section: Non-genetic Factorsmentioning

confidence: 58%

Genetic and Non-Genetic Factors Association with Warfarin Long Term Therapy Stability in Sudan

Aldahab¹,

Elkhawad²

2016

AJPRHC

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Anticoagulation with warfarin is characterized by a wide inter-individual variations in dose requirements and INR (International Normalised Ratio) stability, as there are evidences that warfarin response variability is associated with CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) and VKORC1 (Vitamin K epoxide reductase complex1) genetic polymorphisms. Carriers of CYP2C9*2 and VKORC11639G>A variant alleles are at greater risk of unstable anticoagulation therapy. Objectives: This retrospective case control study was directed to analyze the impact of genetic and non-genetic factors on warfarin therapy in Sudanese out-patients who were on long term warfarin therapy. Method: 118 Sudanese outpatients receiving warfarin treatment for at least six months, were interviewed for their non-genetic factors that included age, sex, indication for warfarin therapy, compliance, Vitamin K rich foods intake and concomitant drug therapy, in addition to their blood samples which were taken for DNA extraction and genotyping of CYP2C9*2 and VKORC11639G>A gene polymorphisms to study the genetic factors. INR stability % index was calculated, accordingly patients were classified into 2 groups, stable and unstable groups. Results: The frequencies of VKORC11639G>A alleles in Sudanese out-patients who were on long term warfarin therapy were 70.3% and 29.7% for the VKORC1/G and VKORC1/A alleles respectively. The frequencies of CYP2C9*2 alleles in Sudanese out-patients were 92.4% and 7.6% for CYP2C9*1 and CYP2C9*2 alleles respectively. Variables associated with low INR stability were VKCOR1/AA genotype (p-value = 0.028) and sex (p = 0.017). Variables that showed no association with INR stability were age (p-value = 0.259), compliance (p-value = 0.058). Vitamin K rich foods intake (p-value = 0.743), and mean stable warfarin dose (p-value = 0.439). Conclusion: Polymorphism in warfarin drug target gene VKORC1-11639G>A and sex are important elements of INR stability in Sudanese out-patients on long term warfarin therapy.

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Anticoagulation control in Sweden: reports of time in therapeutic range, major bleeding, and thrombo-embolic complications from the national quality registry AuriculA

Cited by 221 publications

References 14 publications

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

Rates of hemorrhage during warfarin therapy for atrial fibrillation

Genetic and Non-Genetic Factors Association with Warfarin Long Term Therapy Stability in Sudan

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