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Costa Viana C, da Silva Praxedes MF, Freitas Nunes de Sousa WJ, Bartolazzi F, Sousa Vianna M, Padilha da Silva JL, Parreiras Martins MA. Sex-influence on the time in therapeutic range (TTR) during oral anticoagulation with coumarin derivatives: Systematic review and meta-analysis. Br J Clin Pharmacol 2021; 87:4488-4503. [PMID: 33973668 DOI: 10.1111/bcp.14892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/23/2021] [Accepted: 05/01/2021] [Indexed: 12/17/2022] Open
Abstract
AIMS We sought to investigate the association between sex and oral anticoagulation control employing coumarin derivatives. METHODS Electronic sources were MEDLINE, Biblioteca Virtual em Saúde (BVS), The Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Cochrane Central and Web of Science. Inclusion criteria were: observational and experimental studies; age ≥18 years; both sexes; treatment with any coumarin derivative for ≥3 months; any indication of long-term use; quality of oral anticoagulation measured by time in therapeutic range (TTR). The meta-analysis was developed with odds ratios (OR) for binary variables and mean differences (MD) for continuous variables, using random-effects models (DerSimonian and Laird) with 95% confidence intervals (CI). RESULTS Overall, 22 articles were selected, comprising 16 cohort studies, four cross-sectional studies and two clinical trials. The number of participants ranged from 110 to 104 505 (183 612; women: 45%). The main indication of oral anticoagulation was atrial fibrillation. Most studies reported the use of warfarin. In the meta-analysis, 15 studies were analysed using TTR as a binary variable (OR = 0.87; 95% CI = 0.78, 0.96; z = -2.75; P = .006.; I2 = 67%) and seven studies as a continuous variable (MD = -2.97; 95% CI = -4.80, -1.14; z = -3.19; P = .0014; I2 = 75%). The pooled estimates indicated that women were associated with lower TTR than men. CONCLUSIONS Our findings revealed an association between female sex and worse oral anticoagulation control. Further studies are needed with primary design to investigate sex-related factors influencing oral anticoagulation control with coumarin derivatives. Innovative strategies focused on women's health may be useful to improve patient-centred care.
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Affiliation(s)
- Catiane Costa Viana
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Marcus Fernando da Silva Praxedes
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.,Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia, Av. do Cajueiro 1015, Cajueiro, Santo Antonio de Jesus, Bahia, 44574-490, Brazil
| | - Waleska Jaclyn Freitas Nunes de Sousa
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil.,Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Frederico Bartolazzi
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
| | - Mayara Sousa Vianna
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - José Luiz Padilha da Silva
- Departamento de Estatística da Universidade Federal do Paraná, R. Evaristo F. Ferreira da Costa, 408, Jardim das Américas, Curitiba, Paraná, 81530-015, Brazil
| | - Maria Auxiliadora Parreiras Martins
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil.,Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil.,Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, 30130-100, Brazil
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2
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Takamoto K, Sakamoto JI, Ito S, Kimura T, Manabe E, Shikata T, Asakura M, Ishihara M, Tsujino T. Low Quality of Warfarin Therapy is Associated With Female Gender but Not With Polypharmacy in Patients With Atrial Fibrillation. Front Pharmacol 2021; 12:651799. [PMID: 33981231 PMCID: PMC8110202 DOI: 10.3389/fphar.2021.651799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background: We examined the impact of polypharmacy on the quality of the anticoagulation therapy in patients with atrial fibrillation. We also examined the factors that affect the stability of warfarin therapy. Methods and Results: This retrospective study was conducted using data from 157 consecutive outpatients with atrial fibrillation in a single tertiary referral hospital. Patients who were prescribed warfarin continuously and for whom PT-INR was examined at least three times in a year were included in this study. We examined the quality of warfarin therapy using time in the therapeutic INR range (TTR), percentage of PT-INR determinations in range (PINRR), and the coefficient variation (CV) of PT-INR. We found that the number of prescribed medicines was significantly associated with high BMI and low eGFR, but not with TTR, PINRR, and the coefficient variation of PT-INR in patients with atrial fibrillation. We also found that female gender was independently associated with low PINRR in this study population. Conclusion: Polypharmacy did not deteriorate the quality of warfarin therapy in patients with atrial fibrillation treated in the tertiary referral hospital. Female gender was an independent predictor of the low quality of warfarin therapy.
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Affiliation(s)
- Kojiro Takamoto
- Graduate School of Pharmacy, Hyogo University of Health Sciences, Kobe, Japan.,Hyogo College of Medicine Sasayama Medical Center, Sasayama, Japan
| | - Jun-Ichi Sakamoto
- Graduate School of Pharmacy, Hyogo University of Health Sciences, Kobe, Japan.,Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya, Japan
| | - Satoyasu Ito
- Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe, Japan
| | - Takeshi Kimura
- Department of Pharmacy, Hyogo College of Medicine Hospital, Nishinomiya, Japan
| | - Eri Manabe
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | | | - Masanori Asakura
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Tsujino
- Graduate School of Pharmacy, Hyogo University of Health Sciences, Kobe, Japan.,Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe, Japan.,Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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3
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Zulkifly H, Cheli P, Lutchman I, Bai Y, Lip GYH, Lane DA. Anticoagulation control in different ethnic groups receiving vitamin K antagonist therapy for stroke prevention in atrial fibrillation. Thromb Res 2020; 192:12-20. [PMID: 32416364 DOI: 10.1016/j.thromres.2020.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/18/2020] [Accepted: 04/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Efficacy and safety of vitamin K antagonists (VKAs) is optimised in atrial fibrillation (AF) patients when the International Normalised Ratio (INR) is 2.0-3.0. Anticoagulation control comparing different ethnic groups is limited, although epidemiological studies suggest poorer INR control in non-white cohorts. METHODS VKA control was assessed retrospectively by time-in-the-therapeutic range (TTR) (Rosendaal method) and percentage INR-in-range (PINRR) in 991 White, Afro-Caribbean and South-Asian AF patients [overall mean (SD) age 71.6 (9.4) years; 55% male; mean (SD) CHA2DS2-VASc score 3.4 (1.6)] over a median (IQR) follow-up of 5.2 (3.2-7.0) years. RESULTS Compared to Whites, mean (SD) TTR and PINRR were significantly lower in South-Asians [TTR 67.9% vs. 60.5%; PINRR 58.8% vs. 51.6%, respectively] and Afro-Caribbeans [TTR 67.9% vs. 61.3%; PINRR 58.8% vs. 53.1%, respectively], despite similar INR monitoring intensity. Logistic regression revealed non-white ethnicity [OR 2.62; 95% Confidence Interval [CI] (1.67-4.10) and OR 3.47 (1.44-8.34)] and anaemia [OR 1.65 (1.00-2.70) and OR 6.27 (1.89-20.94)] as independent predictors of both TTR and PINRR < 70%, respectively. At follow-up, 329 (33.2%) patients experienced ≥1 major adverse clinical event. Cardiovascular hospitalisation was significantly higher among South-Asians (32.3%) compared to the Whites and Afro-Caribbeans (21.3% vs 25.6% respectively). CONCLUSIONS Ethnic disparities in quality of anticoagulation control are evident, with South-Asians and Afro-Caribbeans having poorer control compared to Whites, despite similar intensity INR monitoring. Non-white ethnicity remained the strongest independent predictor of poor TTR and PINRR. Interventions to improve anticoagulation control need to be implemented, particularly targeting ethnic minority patients.
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Affiliation(s)
- Hanis Zulkifly
- University of Birmingham Institute of Cardiovascular Sciences, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; Fakulti Farmasi, Universiti Teknologi MARA Kampus Puncak Alam, Selangor, Malaysia
| | - Paola Cheli
- University of Birmingham Institute of Cardiovascular Sciences, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Ivana Lutchman
- University of Birmingham Institute of Cardiovascular Sciences, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.
| | - Ying Bai
- University of Birmingham Institute of Cardiovascular Sciences, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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4
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Botton MR, Viola PP, Meireles MR, Bruxel EM, Zuchinali P, Bandinelli E, Rohde LE, Leiria TLL, Salamoni JYY, Garbin AP, Hutz MH. Identification of environmental and genetic factors that influence warfarin time in therapeutic range. Genet Mol Biol 2020; 43:e20190025. [PMID: 32052826 PMCID: PMC7198020 DOI: 10.1590/1678-4685-gmb-2019-0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/25/2019] [Indexed: 11/22/2022] Open
Abstract
Warfarin is an oral anticoagulant prescribed to prevent and treat thromboembolic disorders. It has a narrow therapeutic window and must have its effect controlled. Prothrombin test, expressed in INR value, is used for dose management. Time in therapeutic range (TTR) is an important outcome of quality control of anticoagulation therapy and is influenced by several factors. The aim of this study was to identify genetic, demographic, and clinical factors that can potentially influence TTR. In total,422 patients using warfarin were investigated. Glibenclamide co-medication and presence of CYP2C9*2 and/or *3 alleles were associated with higher TTR, while amiodarone, acetaminophen and verapamil co-medication were associated with lower TTR. Our data suggest that TTR is influenced by co-medication and genetic factors. Thus, individuals in use of glibenclamide may need a more careful monitoring and genetic testing (CYP2C9*2 and/or *3 alleles) may improve the anticoagulation management. In addition, in order to reach and maintain the INR in the target for a longer period, it is better to discuss dose adjustment in office instead of by telephone assessment. Other studies are needed to confirm these results and to find more variables that could contribute to this important parameter.
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Affiliation(s)
- Mariana R Botton
- Universidade Federal do Rio Grande do Sul, Departamento de Genética, Porto Alegre, RS, Brazil
| | - Patrícia P Viola
- Universidade Federal do Rio Grande do Sul, Departamento de Genética, Porto Alegre, RS, Brazil
| | - Mariana R Meireles
- Universidade Federal do Rio Grande do Sul, Departamento de Genética, Porto Alegre, RS, Brazil
| | - Estela M Bruxel
- Universidade Federal do Rio Grande do Sul, Departamento de Genética, Porto Alegre, RS, Brazil
| | | | - Eliane Bandinelli
- Universidade Federal do Rio Grande do Sul, Departamento de Genética, Porto Alegre, RS, Brazil
| | - Luis E Rohde
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Tiago L L Leiria
- Fundação Universitária de Cardiologia, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Arthur P Garbin
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Mara H Hutz
- Universidade Federal do Rio Grande do Sul, Departamento de Genética, Porto Alegre, RS, Brazil
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5
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Numao Y, Suzuki S, Arita T, Yagi N, Otsuka T, Sagara K, Semba H, Sasaki K, Kano H, Matsuno S, Kato Y, Uejima T, Oikawa Y, Nagashima K, Kirigaya H, Kunihara T, Yajima J, Aizawa T, Yamashita T. Predictors of International Normalized Ratio Variability in Patients With Atrial Fibrillation Under Warfarin Therapy. Circ J 2018. [DOI: 10.1253/circj.cj-16-1217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yoshimi Numao
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Takuto Arita
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Naoharu Yagi
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Takayuki Otsuka
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Koichi Sagara
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Hiroaki Semba
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Kenichi Sasaki
- Department of Cardiovascular Surgery, The Cardiovascular Institute
| | - Hiroto Kano
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Shunsuke Matsuno
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yuko Kato
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Tokuhisa Uejima
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yuji Oikawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | | | - Hajime Kirigaya
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Takashi Kunihara
- Department of Cardiovascular Surgery, The Cardiovascular Institute
| | - Junji Yajima
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Tadanori Aizawa
- Department of Cardiovascular Medicine, The Cardiovascular Institute
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6
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Lin KJ, Singer DE, Glynn RJ, Blackley S, Zhou L, Liu J, Dube G, Oertel LB, Schneeweiss S. Prediction Score for Anticoagulation Control Quality Among Older Adults. J Am Heart Assoc 2017; 6:JAHA.117.006814. [PMID: 28982676 PMCID: PMC5721874 DOI: 10.1161/jaha.117.006814] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Time in the therapeutic range (TTR) is associated with the effectiveness and safety of vitamin K antagonist (VKA) therapy. To optimize prescribing of VKA, we aimed to develop and validate a prediction model for TTR in older adults taking VKA for nonvalvular atrial fibrillation and venous thromboembolism. Methods and Results The study cohort comprised patients aged ≥65 years who were taking VKA for atrial fibrillation or venous thromboembolism and who were identified in the 2 US electronic health record databases linked with Medicare claims data from 2007 through 2014. With the predictors identified from a systematic review and clinical knowledge, we built a prediction model for TTR, using one electronic health record system as the training set and the other as the validation set. We compared the performance of the new models to that of a published prediction score for TTR, SAMe‐TT2R2. Based on 1663 patients in the training set and 1181 in the validation set, our optimized score included 42 variables and the simplified model included 7 variables, abbreviated as PROSPER (Pneumonia, Renal dysfunction, Oozing blood [prior bleeding], Staying in hospital ≥7 days, Pain medication use, no Enhanced [structured] anticoagulation services, Rx for antibiotics). The PROSPER score outperformed SAMe‐TT2R2 when predicting both TTR ≥70% (area under the receiver operating characteristic curve 0.67 versus 0.55) and the thromboembolic and bleeding outcomes (area under the receiver operating characteristic curve 0.62 versus 0.52). Conclusions Our geriatric TTR score can be used as a clinical decision aid to select appropriate candidates to receive VKA therapy and as a research tool to address confounding and treatment effect heterogeneity by anticoagulation quality.
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Affiliation(s)
- Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA .,Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Daniel E Singer
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Robert J Glynn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Suzanne Blackley
- Clinical and Quality Analysis, Information Systems, Partners HealthCare System, Boston, MA
| | - Li Zhou
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Clinical Informatics, Partners eCare, Partners HealthCare System, Boston, MA
| | - Jun Liu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gina Dube
- Department of Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Lynn B Oertel
- Anticoagulation Management Service, Department of Nursing, Massachusetts General Hospital, Boston, MA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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7
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Odashiro K, Yokoyama T, Fukata M, Arita T, Maruyama T, Akashi K. Anticoagulation Stability Depends on CHADS 2 Score and Hepatorenal Function in Warfarin-treated Patients, Including Those with Atrial Fibrillation. J Atheroscler Thromb 2016; 24:68-76. [PMID: 27319745 PMCID: PMC5225134 DOI: 10.5551/jat.35121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Although warfarin remains important despite the widespread use of nonvitamin K antagonist oral anticoagulants (NOACs), to date, the reality of warfarin use in the "NOACs era" is unclear. This multicenter observational study aimed to clarify the key factors contributing to warfarin treatment stability. METHODS The practical use of warfarin, stability of warfarin therapy, and factors contributing to this stability were investigated in community-based hospitals through a real-world study. Clinical data were retrospectively extracted from the medical records of warfarin-treated Japanese patients (age, 71.3±5.5 years) with atrial fibrillation (AF), prosthetic heart valve, or other concerns requiring anticoagulation. Treatment stability was considered as time in therapeutic range of international normalized ratio of prothrombin time (TTR: %). The factors contributing to TTR were investigated, including CHADS2 score components. RESULTS Mean CHADS2 score was highest (1.38±0.88, p<0.001), and most CHADS2 score components in addition to hepatorenal dysfunction were factors contributing to the low TTR in patients with AF (n=176). The similarity was found in overall patients who were prescribed warfarin (n= 518). TTR decreased according to the CHADS2 score component accumulation. Gender, dose and prescription interval of warfarin, and co-administration of antiplatelet agents did not correlate with the low TTR. CONCLUSIONS This retrospective study demonstrated that the CHADS2 score component accumulation and hepatorenal dysfunction are factors significantly contributing to the low TTR, which is indicative of poor warfarin treatment stability, in patients such as those with AF.
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Affiliation(s)
- Keita Odashiro
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences
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8
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Repercusiones en la posología de los anticoagulantes orales no antagonistas de la vitamina K por las variaciones de la función renal de los pacientes con fibrilación auricular e insuficiencia cardiaca aguda reciente. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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9
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Esteve-Pastor MA, Roldán V, Valdés M, Lip GYH, Marín F. The SAMe-TT2R2score and decision-making between a vitamin K antagonist or a non-vitamin K antagonist oral anticoagulant in patients with atrial fibrillation. Expert Rev Cardiovasc Ther 2015; 14:177-87. [DOI: 10.1586/14779072.2016.1116941] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Nezu T, Hosomi N, Kondo K, Aoki S, Matsumoto M, Kobayashi S. Greater Severity of Neurological Defects in Women Admitted With Atrial Fibrillation-Related Stroke. Circ J 2015; 80:250-5. [PMID: 26511462 DOI: 10.1253/circj.cj-15-0873] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The magnitude of the CHA2DS2-VASc score is associated with not only stroke incidence but also long-term outcomes. The association between sex and initial stroke severity in AF-related cardioembolic stroke patients has not been clarified. The present study aimed to elucidate the risk factors for initial stroke severity among patients with cardioembolic stroke enrolled in a multicenter registry. METHODS AND RESULTS We selected 12,701 patients (age, 77±10 years; 5,653 women) with AF-related cardioembolic stroke from the Japan Standard Stroke Registry Study between January 2000 and July 2013. Indicators of National Institutes of Health Stroke Scale (NIHSS) scores at admission were identified using a multiple linear regression. Increased NIHSS scores positively correlated with CHA2DS2-VASc score (ρ=0.197; P<0.001). The initial neurological deficits were more severe in women than in men (NIHSS scores, median [interquartile range] 14 [5-22] vs. 8 [3-18]; P<0.001). Multiple regression analysis revealed that higher age (standardized partial regression coefficient [β] 0.162; P<0.001), female sex (β 0.120; P<0.001), diabetes mellitus (β 0.020; P=0.019), dyslipidemia (β -0.076; P<0.001), congestive heart failure (β 0.039; P<0.001), vascular disease (β 0.030; P=0.001), prior stroke/TIA (β 0.085; P<0.001) and prior anticoagulant use (β -0.020; P=0.028) were associated with the NIHSS score at admission. CONCLUSIONS Female sex was independently associated with the initial neurological severity among AF-related cardioembolic stroke patients.
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Affiliation(s)
- Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical & Health Sciences
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11
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Andreu-Cayuelas JM, Pastor-Pérez FJ, Puche CM, Mateo-Martínez A, García-Alberola A, Flores-Blanco PJ, Valdés M, Lip GYH, Roldán V, Manzano-Fernández S. Impact of Variations in Kidney Function on Nonvitamin K Oral Anticoagulant Dosing in Patients With Atrial Fibrillation and Recent Acute Heart Failure. ACTA ACUST UNITED AC 2015; 69:134-40. [PMID: 26607030 DOI: 10.1016/j.rec.2015.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/22/2015] [Indexed: 01/22/2023]
Abstract
INTRODUCTION AND OBJECTIVES Renal impairment and fluctuations in renal function are common in patients recently hospitalized for acute heart failure and in those with atrial fibrillation. The aim of the present study was to evaluate the hypothetical need for dosage adjustment (based on fluctuations in kidney function) of dabigatran, rivaroxaban and apixaban during the first 6 months after hospital discharge in patients with concomitant atrial fibrillation and heart failure. METHODS An observational study was conducted in 162 patients with nonvalvular atrial fibrillation after hospitalization for acute decompensated heart failure who underwent creatinine determinations during follow-up. The hypothetical recommended dosage of dabigatran, rivaroxaban and apixaban according to renal function was determined at discharge. Variations in serum creatinine and creatinine clearance and consequent changes in the recommended dosage of these drugs were identified during 6 months of follow-up. RESULTS Among the overall study population, 44% of patients would have needed dabigatran dosage adjustment during follow-up, 35% would have needed rivaroxaban adjustment, and 29% would have needed apixaban dosage adjustment. A higher proportion of patients with creatinine clearance < 60 mL/min or with advanced age (≥ 75 years) would have needed dosage adjustment during follow-up. CONCLUSIONS The need for dosage adjustment of nonvitamin K oral anticoagulants during follow-up is frequent in patients with atrial fibrillation after acute decompensated heart failure, especially among older patients and those with renal impairment. Further studies are needed to clarify the clinical importance of these needs for drug dosing adjustment and the ideal renal function monitoring regime in heart failure and other subgroups of patients with atrial fibrillation.
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Affiliation(s)
- José M Andreu-Cayuelas
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Francisco J Pastor-Pérez
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Carmen M Puche
- Laboratorio de Análisis Clínicos, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Alicia Mateo-Martínez
- Servicio de Cardiología, Hospital Universitario Los Arcos del Mar Menor, San Javier, Murcia, Spain
| | - Arcadio García-Alberola
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Pedro J Flores-Blanco
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Mariano Valdés
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Gregory Y H Lip
- Centre for Cardiovascular Sciences, City Hospital, University of Birmingham, United Kingdom
| | - Vanessa Roldán
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Sergio Manzano-Fernández
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain.
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Rouaud A, Hanon O, Boureau AS, Chapelet GG, de Decker L. Comorbidities against quality control of VKA therapy in non-valvular atrial fibrillation: a French national cross-sectional study. PLoS One 2015; 10:e0119043. [PMID: 25789771 PMCID: PMC4366229 DOI: 10.1371/journal.pone.0119043] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 01/09/2015] [Indexed: 01/21/2023] Open
Abstract
Background Given the prevalence of non-valvular atrial fibrillation in the geriatric population, thromboembolic prevention by means of vitamin K antagonists (VKA) is one of the most frequent daily concerns of practitioners. The effectiveness and safety of treatment with VKA correlates directly with maximizing the time in therapeutic range, with an International Normalized Ratio (INR) of 2.0-3.0. The older population concentrates many of factors known to influence INR rate, particularly concomitant medications and concurrent medical conditions, also defined as comorbidities. Objective Determine whether a high burden on comorbidities, defined by a Charlson Comorbidity Index (CCI) of 3 or greater, is associated a lower quality of INR control. Study-Design Cross-sectional study. Settings French geriatric care units nationwide. Participants 2164 patients aged 80 and over and treated with vitamin K antagonists. Measurements Comorbidities were assessed using the Charlson Comorbidity Index (CCI). The recorded data included age, sex, falls, kidney failure, hemorrhagic event, VKA treatment duration, and the number and type of concomitant medications. Quality of INR control, defined as time in therapeutic range (TTR), was assessed using the Rosendaal method. Results 487 patients were identified the low-quality control of INR group. On multivariate logistic regression analysis, low-quality control of INR was independently associated with a CCI ≥3 (OR = 1.487; 95% CI [1.15; 1.91]). The other variables associated with low-quality control of INR were: hemorrhagic event (OR = 3.151; 95% CI [1.64; 6.07]), hospitalization (OR = 1.614, 95% CI [1.21; 2.14]). Conclusion An elevated CCI score (≥3) was associated with low-quality control of INR in elderly patients treated with VKA. Further research is needed to corroborate this finding.
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Affiliation(s)
- Agnes Rouaud
- Department of Geriatrics, EA 1156–12, Nantes University Hospital, Nantes, France
- * E-mail:
| | - Olivier Hanon
- Department of Geriatrics, Broca Hospital, Public Hospital of Paris, Paris, France
| | - Anne-Sophie Boureau
- Department of Geriatrics, EA 1156–12, Nantes University Hospital, Nantes, France
| | | | - Laure de Decker
- Department of Geriatrics, EA 1156–12, Nantes University Hospital, Nantes, France
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VKORC1 and CYP2C9 genotype distribution in Asian countries. Thromb Res 2014; 134:537-44. [DOI: 10.1016/j.thromres.2014.05.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/04/2014] [Accepted: 05/16/2014] [Indexed: 01/21/2023]
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