Dataset Information

Quality of Anticoagulation With Vitamin K Antagonists.

ABSTRACT:

Background

Vitamin K antagonists (VKA) have a narrow therapeutic range, and literature analysis reveals poor quality of anticoagulation control. We sought to assess the prevalence of poor anticoagulant control in patients under VKA treatment in the prevention of stroke for atrial fibrillation (AF).

Hypothesis

Control of anticoagulation with VKA is inadequate in a high percentage of patients with AF.

Methods

Patients with AF under VKA treatment were prospectively recruited in this observational registry. The sample comprised 948 patients. The estimated time spent in the therapeutic range (TTR) was calculated, and variables related with a TTR >65% were analyzed.

Results

Mean age was 73.8 ± 9.4 years, and 42.5% of the patients were women. Mean TTR was 63.77% ± 23.80% for the direct method and 60.27% ± 24.48% for the Rosendaal method. Prevalence of poor anticoagulation control was 54%. Variables associated with good anticoagulation control were university studies (odds ratio [OR]: 1.99, 95% confidence interval [CI]: 1.08-3.64), chronic hepatic disease (OR: 8.15, 95% CI: 1.57-42.24), low comorbidity expressed as Charlson index (OR: 0.87, 95% CI: 0.76-0.99), no previous cardiac disease (OR: 0.64, 95% CI: 0.41-0.98), lower risk of bleeding assessed as hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly age, and use of drugs or alcohol (HAS-BLED; OR: 0.81, 95% CI: 0.69-0.95), and lower heart rate (OR: 0.99, 95% CI: 0.98-0.99).

Conclusions

Patients who receive VKA to prevent stroke for AF spend less than half the time within therapeutic range.

SUBMITTER: Bertomeu-Gonzalez V

PROVIDER: S-EPMC6711074 | biostudies-literature | 2015 Jun

REPOSITORIES: biostudies-literature

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Publications

Quality of Anticoagulation With Vitamin K Antagonists.

Bertomeu-González Vicente V Anguita Manuel M Moreno-Arribas José J Cequier Ángel Á Muñiz Javier J Castillo-Castillo Jesús J Sanchis Juan J Roldán Inmaculada I Marin Francisco F Bertomeu-Martínez Vicente V

Clinical cardiology 20150511 6

<h4>Background</h4>Vitamin K antagonists (VKA) have a narrow therapeutic range, and literature analysis reveals poor quality of anticoagulation control. We sought to assess the prevalence of poor anticoagulant control in patients under VKA treatment in the prevention of stroke for atrial fibrillation (AF).<h4>Hypothesis</h4>Control of anticoagulation with VKA is inadequate in a high percentage of patients with AF.<h4>Methods</h4>Patients with AF under VKA treatment were prospectively recruited i ...[more]

PMID: 25962838

Similar Datasets

Project description:BackgroundIn Germany, patients receiving oral anticoagulation (OAC) are often treated by general practitioners (GPs), and large proportions of patients receive vitamin K antagonists (VKAs). The quality of OAC in German GP practices, differences between various practices, and improvement potential through implementation of case management, have not yet been investigated satisfactorily. Based on results of a cluster-randomized controlled trial, we aimed to assess whether OAC quality can be improved, any variations between practices exist and determine practice- and patient-level factors.MethodsThe PICANT trial (2012-2015) was performed in 52 GP practices in Hesse, Germany. Adult patients with long-term indication for OAC received best practice case management in the intervention group. International normalized ratio (INR) values were recorded from anticoagulation passes. The Rosendaal method was used to calculate Time in Therapeutic Range (TTR) at patient level, and mean pooling to obtain center-specific TTR (cTTR) at practice level. The quality of OAC was assessed by TTR and cTTR. Linear model analyses were used to investigate associations between practice-/ patient-level factors and TTR.ResultsInclusion of 736 patients (49.6% intervention and 50.4% control patients); 690 (93.8%) received phenprocoumon. Within 24?months, the TTR was 75.1% (SD 17.6) in the intervention versus 74.3% (SD 17.8) in the control group (p?=?0.670). The cTTR averaged 75.1% (SD 6.5, range: 60.4 to 86.7%) in the intervention versus 74.3% (SD 7.2, range: 52.7 to 85.7%) in the control group (p?=?0.668). At practice level, the TTR was significantly lower in practices with a male physician and certification in quality management. At patient level, the TTR was significantly higher in patients with moderate to high compliance, in men, and in patients that performed self-management. The TTR was significantly lower in patients with certain comorbidities, and who were hospitalized.ConclusionsThe intervention did not effectively improve OAC quality compared to routine care. Quality of INR control was generally good, but considerable variation existed between GP practices. The variability indicates optimization potential in some practices. The demonstrated association between patient-level factors and TTR highlights the importance of considering patient characteristics that may impede achieving high quality therapeutic outcomes.Trial registrationISRCTN registry, ISRCTN41847489 , registered 27 February 2012.

Dataset Information

Quality of Anticoagulation With Vitamin K Antagonists.

Background

Hypothesis

Methods

Results

Conclusions

Publications

Quality of Anticoagulation With Vitamin K Antagonists.

Similar Datasets

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