Anticoagulation treatment for the reduction of stroke in atrial fibrillation: a cohort study to examine the gap between guidelines and routine medical practice

McBride, Doreen; Brüggenjürgen, Bernd; Roll, Stephanie; Willich, Stefan N.

doi:10.1007/s11239-006-0002-8

Cited by 47 publications

(36 citation statements)

References 35 publications

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“…Only 3 articles reported on cohorts including subjects receiving different VKAs (including warfarin), 14 -16 and the VKA used was not reported in 1 article. 17 Thirty-two articles used a target range of 2.0 to 3.0, and 6 articles 18 -23 reported slight variations on this range (ie, 2.0 to 3.5).…”

Section: Resultsmentioning

confidence: 99%

Anticoagulation Control and Prediction of Adverse Events in Patients With Atrial Fibrillation

Wan

Heneghan

Perera

et al. 2008

Circ: Cardiovascular Quality and Outcomes

476

354

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Section: Resultsmentioning

confidence: 99%

Anticoagulation Control and Prediction of Adverse Events in Patients With Atrial Fibrillation

Wan

Heneghan

Perera

et al. 2008

Circ: Cardiovascular Quality and Outcomes

476

354

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“…This overall standard of INR control seems better than in usual clinical practice, which often reports lower TTR. [18][19][20][21] However, in sites and countries with a more optimal anticoagulation service, even better results can be achieved. 22 The median TTR in ARISTOTLE was similar to that observed in several previous open-label warfarin controlled trials 10,11,23 and higher than that observed in a previous double-blind trial.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Apixaban Compared With Warfarin at Different Levels of Predicted International Normalized Ratio Control for Stroke Prevention in Atrial Fibrillation

et al. 2013

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Fibrillation (ARISTOTLE) trial, apixaban compared with warfarin reduced stroke and systemic embolism, major bleeding, and mortality. We evaluated treatment effects in relation to 2 predictions of time in therapeutic range (TTR). Methods and Results-The trial randomized 18 201 patients with atrial fibrillation to apixaban 5 mg twice daily or warfarin for at least 12 months. For each patient, a center average TTR was estimated with the use of a linear mixed model on the basis of the real TTRs in its warfarin-treated patients, with a fixed effect for country and random effect for center. For each patient, an individual TTR was also predicted with the use of a linear mixed effects model including patient characteristics as well. Median center average TTR was 66% (interquartile limits, 61% and 71%). Rates of stroke or systemic embolism, major bleeding, and mortality were consistently lower with apixaban than with warfarin across center average TTR and individual TTR quartiles. In the lowest and highest center average TTR quartiles, hazard ratios for stroke or systemic embolism were 0.73 (95% confidence interval [CI], 0.53-1.00) and 0.88 (95% CI, 0.57-1.35) (P interaction =0.078), for mortality were 0.91 (95% CI, 0.74-1.13) and 0.91 (95% CI, 0.71-1.16) (P interaction =0.34), and for major bleeding were 0.50 (95% CI, 0.36-0.70) and 0.75 (95% CI, 0.58-0.97) (P interaction =0.095), respectively. Similar results were seen for quartiles of individual TTR.© 2013 American Heart Association, Inc.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.112.142158Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz. W arfarin and other vitamin K antagonists effectively prevent stroke in patients with atrial fibrillation (AF), but they have a narrow therapeutic window with an increased risk of stroke and bleeding when above or below the therapeutic range of the international normalized ratio (INR) of 2.0 to 3.0.1-3 The dose response is influenced by several factors such as age, body weight, genetic variation, food, and comedications. Regular INR-guided dose adjustments are therefore necessary.1-3 However, there are large variations of the time in therapeutic range (TTR) across individuals, sites, and countries, and these variations are related to patient outcomes. [4][5][6][7][8][9] Several trials have shown recently that the quality of warfarin use, as measured with INR control at the center or country level, may interact with the treatment effects of new antithrombotic treatments when compared with warfarin. 10-12 Editorial see p 2163 Clinical Perspective on p 2176Apixaban is a new oral direct factor Xa inhibitor providing stable anticoagulation at a fixed dose twice daily without the need for anticoagulation monitoring. In the prospective, randomized, and double-blind Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial including 18 201 patients with AF and at least 1 additiona...

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“…Some of these studies did not reflect routine care (7,8), failed to include elderly AF patients (9) or were limited by low numbers of AF cases (9,10). Moreover, the proportion of AF patients receiving antithrombotic drugs was possibly overestimated, since field studies based on voluntary participation of the treating physicians may have overrepresented those who already provide adequate antithrombotic treatment to their AF patients (7,8,10,11).…”

Section: Introductionmentioning

confidence: 99%

Incidence, prevalence and 1-year all-cause mortality of heart failure in Germany: a study based on electronic healthcare data of more than six million persons

et al. 2015

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CitationIncidence, prevalence and 1-year all-cause mortality of heart failure in Germany: a study based on electronic healthcare data of more than six million persons. Abstract AimsData on the epidemiology of atrial fibrillation (AF) and its antithrombotic management in elderly populations are scarce. The aims of this study were to estimate the incidence and prevalence of AF in the elderly in Germany and to describe antithrombotic management of AF cases. MethodsEstimation of prevalence and incidence was based on data of three German statutory health insurances, which insured more than 800,000 people aged 65 years and older in the study Treatment was less common among women and older people. ConclusionIncidence and prevalence of AF are relatively high in the elderly in Germany. A considerable fraction of new AF cases did not receive antithrombotic drugs in routine care.

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Anticoagulation treatment for the reduction of stroke in atrial fibrillation: a cohort study to examine the gap between guidelines and routine medical practice

Abstract: This study presents 'real-life' data in treating patients with AF in Germany and identifies the potential to advance the quality of care with respect to anticoagulation.

Cited by 47 publications

References 35 publications

Anticoagulation Control and Prediction of Adverse Events in Patients With Atrial Fibrillation

Anticoagulation Control and Prediction of Adverse Events in Patients With Atrial Fibrillation

Efficacy and Safety of Apixaban Compared With Warfarin at Different Levels of Predicted International Normalized Ratio Control for Stroke Prevention in Atrial Fibrillation

Incidence, prevalence and 1-year all-cause mortality of heart failure in Germany: a study based on electronic healthcare data of more than six million persons

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