Suboptimal Time in Therapeutic Range (TTR) for International Normalized Ratio (INR) Measurements Observed in an Outpatient Cardiology Clinic: Impact of Gender, Ethnicity, Disease Etiology, Chadsvasc Score, Physicians and Clinic Site

2013 ◽  
Vol 29 (10) ◽  
pp. S185
Author(s):  
N Singh ◽  
S Premji ◽  
S Chandra ◽  
D Song ◽  
L Yan ◽  
...  
Keyword(s):  
Therapeutic Range ◽  
International Normalized Ratio ◽  
Disease Etiology ◽  
Time In Therapeutic Range ◽  
Clinic Site ◽  
Cardiology Clinic

scholarly journals Poor Time in Therapeutic Range Control is Associated with Adverse Clinical Outcomes in Patients with Non-Valvular Atrial Fibrillation: A Report from the Nationwide COOL-AF Registry

2020 ◽  
Vol 9 (6) ◽  
pp. 1698 ◽  
Author(s):  
Rungroj Krittayaphong ◽  
Thoranis Chantrarat ◽  
Roj Rojjarekampai ◽  
Pongpun Jittham ◽  
Poom Sairat ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Therapeutic Range ◽  
Major Bleeding ◽  
Stroke Prevention ◽  
International Normalized Ratio ◽  
Time In Therapeutic Range ◽  
Hazard Ratios ◽  
The Relationship

Background: Warfarin remains the most commonly used oral anticoagulant (OAC) in Thailand for stroke prevention among patients with non-valvular atrial fibrillation (NVAF). The aim of this study was to investigate the relationship between time in therapeutic range (TTR) after warfarin initiation and clinical outcomes of NVAF. Methods: TTR was calculated by the Rosendaal method from international normalized ratio (INR) data acquired from a nationwide NVAF registry in Thailand. Patients were followed-up every six months. The association between TTR and clinical outcomes was analyzed. Results: There was a total of 2233 patients from 27 hospitals. The average age was 68.4 ± 10.6 years. The average TTR was 53.56 ± 26.37%. Rates of ischemic stroke/TIA, major bleeding, ICH, and death were 1.33, 2.48, 0.76, and 3.3 per 100 person-years, respectively. When patients with a TTR < 65% were compared with those with TTR ≥ 65%, the adjusted hazard ratios (aHR) for the increased risks of ischemic stroke/TIA, major bleeding, ICH, and death were 3.07, 1.90, 2.34, and 2.11, respectively. Conclusion: Poor TTR control is associated with adverse clinical outcomes in patients with NVAF who were on warfarin. Efforts to ensure good TTR (≥65%) after initiation of warfarin are mandatory to minimize the risk of adverse clinical outcomes.

scholarly journals Evaluation of Bleeding Rate and Time in Therapeutic Range in Patients Using Warfarin Before and During the COVID-19 Pandemic—Warfarin Treatment in COVID-19

2021 ◽  
Vol 27 ◽  
pp. 107602962110214
Author(s):  
Zeynep Yapan Emren ◽  
Oktay Şenöz ◽  
Ahmet Erseçgin ◽  
Sadık Volkan Emren
Keyword(s):  
Therapeutic Range ◽  
Treatment Process ◽  
International Normalized Ratio ◽  
Bleeding Complications ◽  
Demographic Parameters ◽  
Bleeding Rate ◽  
Time In Therapeutic Range ◽  
Warfarin Treatment ◽  
The Mean

The treatment process of patients using warfarin is expected to be hindered during the COVID-19 pandemic. Therefore we investigated whether the time in therapeutic range (TTR) and bleeding complications were affected during the COVID-19 pandemic. 355 patients using warfarin were included between March 2019 to March 2021. Demographic parameters, INR (international normalized ratio), and bleeding rates were recorded retrospectively. The TTR value was calculated using Rosendaal’s method. The mean age of the patients was 61 ± 12 years and 55% of them were female. The mean TTR value during the COVID-19 pandemic was lower than the pre-COVID-19 period (56 ± 21 vs 68 ± 21, P < 0.001). Among the patients, 41% had a lack of outpatient INR control. During the COVID-19 pandemic, 71 (20%) patients using VKA suffered bleeding. Among patients with bleeding, approximately 60% did not seek medical help and 6% of patients performed self-reduction of the VKA dose. During the COVID-19 pandemic, TTR values have decreased with the lack of monitoring. Furthermore, the majority of patients did not seek medical help even in case of bleeding.

scholarly journals Accuracy of an adherence score and time in therapeutic range among patients on chronic use of vitamin K antagonists

2021 ◽  
Vol 10 (8) ◽  
pp. e59510816523
Author(s):  
Sérgio Henrique Simonetti ◽  
Gustavo Bernardes de Figueiredo Oliveira ◽  
Fabiana Cristina Lourenço ◽  
França João Ítalo Dias
Keyword(s):  
Educational Intervention ◽  
Vitamin K ◽  
Therapeutic Range ◽  
High Performance ◽  
Vitamin K Antagonists ◽  
International Normalized Ratio ◽  
Time In Therapeutic Range ◽  
Adherence Score ◽  
Chronic Use

To validate and analyze the accuracy of the Simonetti adherence score among patients on chronic use of vitamin K antagonists and their time in therapeutic range (TTR) of the international normalized ratio as a measure of quality of anticoagulation. A prospective cohort study with a nonrandomized intervention in patients from an anticoagulation center of a public hospital. Baseline data were collected from May to September 2017, and follow-up data were obtained eight months after a nurse-led  educational intervention, which was given to all patients after consent form and after applying the adherence score (N=205). The intervention was undertaken through 30-40 min conversation about relevant factors that had been previously identified in the score derivation study, which comprised drug-drug interactions, inadequate OAC use, comorbidities, effects of food on vitamin K absorption, and invasive procedures. A receiver operating characteristic (ROC) curve was applied to validate the adherence score in terms of prediction of INR out of recommended therapeutic range. At baseline, mean adherence score was 44.69 and standard deviation (SD) was 18.37, and   mean TTR was 41.07 (SD 15.40). Patients were reassessed after   8 months. At follow-up, there were significant improvements in mean adherence score 54.28 (SD 13.13), and in mean TTR 50.99 (SD 26.10). The Simonetti adherence score yielded high performance and accuracy in clinical practice among patients on chronic use of vitamin K antagonists. Our data indicate that nurse led educational intervention yielded favorable impact in terms of adherence score and TTR improvements.

scholarly journals Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 365
Author(s):  
Rubén Ángel Martín-Sánchez ◽  
Noel Lorenzo-Villalba ◽  
Alberto Elpidio Calvo-Elías ◽  
Ester Emilia Dubón-Peralta ◽  
Cynthia Elisa Chocrón-Benbunan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Therapeutic Range ◽  
Oral Anticoagulation ◽  
Statistical Significance ◽  
International Normalized Ratio ◽  
Time In Therapeutic Range ◽  
Patients With Heart Failure ◽  
Hemorrhagic Events ◽  
Early Readmission ◽  
The Relationship

Background and objectives: Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study was to evaluate the relationship between time in therapeutic range (TTR) and the risk of early readmission. Materials and Methods: A retrospective descriptive study was carried out on hospitalized patients with a diagnosis of HF between 2014 and 2018 who had adverse effects due to oral anticoagulation with acenocoumarol (underdosing, overdosing, or hemorrhage). Clinical, analytical, therapeutic, and prognostic variables were collected. TTR is defined as the duration of time in which the patient’s International Normalized Ratio (INR) values were within a desired range. Early readmission was defined as readmission within 30 days after hospital discharge. Patients were divided into two groups depending on whether or not they had a TTR less than 60% (TTR < 60%) over the 6 months prior to the adverse event. Results: In the cohort of 304 patients, the mean age was 82 years, 59.9% of the patients were female, and 54.6% had a TTR < 60%. Patients with TTR < 60% had a higher HAS-BLED score (4.04 vs. 2.59; p < 0.001) and INR (6 vs. 5.31; p < 0.05) but lower hemoglobin (11.67 vs. 12.22 g/dL; p < 0.05). TTR < 60% was associated with early readmission after multivariate analysis (OR: 2.05 (CI 95%: 1.16–3.61)). They also had a higher percentage of hemorrhagic events and in-hospital mortality but without reaching statistical significance. Conclusions: Patients with HF and adverse events due to acenocoumarol often have poor INR control, which is independently associated with a higher risk of early readmission.

Die klinische Bedeutung des TTR bei der oralen Antikoagulation in Studien und klinischem Alltag

2016 ◽  
Vol 73 (10) ◽  
pp. 589-594
Author(s):  
Hans Rickli ◽  
Micha T. Maeder
Keyword(s):  
Vitamin K ◽  
Therapeutic Range ◽  
International Normalized Ratio ◽  
Orale Antikoagulation ◽  
Time In Therapeutic Range ◽  
Klinische Bedeutung

Zusammenfassung. Die orale Antikoagulation (OAK) mit Vitamin-K-Antagonisten (VKA) ist eine wirksame Therapie mit einem schmalen therapeutischen Fenster ausgedrückt im therapeutischen INR (International Normalized Ratio)-Bereich. Gemäss bestehender Literatur beeinflusst die INR-Stabilität die Rate von thromboembolischen Ereignissen, Blutungen und Behandlungskosten. Eine TTR (Time in Therapeutic Range) von > 65 % ist definiert als stabile INR-Kontrolle. Im klinischen Alltag ist dies selten erreicht, was gleichbedeutend ist mit einem erhöhten Blutungs- bzw. Thromboembolierisiko. Verschiedene Faktoren wie jüngeres Alter, Malcompliance, verschiedene Polymorphismen wie CYP2C9 oder VKORC1 und Komorbidität sind assoziiert mit einer ungenügenden INR-Kontrolle. Klinische Tools zur Voraussage einer ungenügenden INR-Kontrolle können weniger als 10 % von deren Varianz erklären. Im klinischen Alltag ist bei Notwendigkeit einer OAK mit VKA Sorgfalt gefragt, und bei geeigneten Patienten ist die Option des Einsatzes von Direkten Oralen Antikoagulantien (DOAKs) in Betracht zu ziehen.

Renal Function, Time in Therapeutic Range and Outcomes in Warfarin-Treated Atrial Fibrillation Patients: A Retrospective Analysis of Nationwide Registries

2017 ◽  
Vol 117 (12) ◽  
pp. 2291-2299 ◽  
Author(s):  
Anders Bonde ◽  
Gregory Lip ◽  
Anne-Lise Kamper ◽  
Laila Staerk ◽  
Christian Torp-Pedersen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Therapeutic Range ◽  
Cox Regression ◽  
International Normalized Ratio ◽  
Adverse Outcomes ◽  
Time In Therapeutic Range ◽  
Anticoagulation Control ◽  
The Impact ◽  
Reduced Renal Function

AbstractPatients with severely reduced renal function have been excluded from randomized controlled trials of oral anticoagulation in atrial fibrillation (AF). Warfarin treatment in this population is controversial and data on anticoagulation control and the impact on adverse outcomes are needed. By individual-level linkage of nationwide registries, we identified all patients discharged from hospitals with AF in Denmark between 1997 and 2011. Patients with available serum creatinine tests were categorized according to the estimated glomerular filtration rate (eGFR). Time in therapeutic range (TTR) was calculated using the Rosendaal method. The risk of stroke and bleeding was estimated using multivariable Cox regression analyses with eGFR and TTR estimated time dependently throughout follow-up. We identified 10,423 warfarin-treated AF patients with available international normalized ratio and creatinine tests; 5,527 with eGFR > 60 mL/min/1.73 m2, 4,524 with eGFR 30–60 mL/min/1.73 m2 and 372 with eGFR < 30 mL/min/1.73 m2. Median TTR was 66.7, 61.2 and 49.7% in patients with eGFR > 60, 30–59 and <30 mL/min/1.73 m2, respectively. A TTR < 70% was associated with a higher risk of stroke/thromboembolism (hazard ratio [HR]: 1.39; 95% confidence interval [CI]: 1.20–1.60) and bleeding (HR: 1.22; 95% CI: 1.05–1.42) among patients with eGFR of 30 to 59 and a trend towards higher risk of stroke/thromboembolism (HR: 1.24; 95% CI: 0.86–1.80) and bleeding (HR: 1.17; 95% CI: 0.83–1.65) among patients with eGFR < 30 mL/min/1.73 m2. In conclusion, warfarin-treated AF patients with reduced renal function have suboptimal anticoagulation control which was related to the risk of adverse outcomes.

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