Time-in-therapeutic-range defined warfarin and direct oral anticoagulants in atrial fibrillation: a Nationwide Cohort Study

被引：4

作者：

Lehto, Mika ^{[1
,2
,12
]}

Luojus, Alex ^{[2
]}

Halminen, Olli ^{[3
]}

Haukka, Jari ^{[2
]}

Putaala, Jukka ^{[2
,4
]}

Linna, Miika ^{[3
,5
]}

Mustonen, Pirjo ^{[6
,7
]}

Kinnunen, Janne ^{[2
,4
]}

Lehtonen, Ossi ^{[5
]}

Teppo, Konsta ^{[6
,7
]}

Tiili, Paula ^{[2
,4
]}

Kouki, Elis ^{[2
]}

Itainen-Stromberg, Saga ^{[2
,8
]}

Niemi, Mikko ^{[9
,10
]}

Aro, Aapo L. ^{[2
,8
]}

Hartikainen, Juha ^{[5
,11
]}

Airaksinen, K. E. Juhani ^{[6
,7
]}

机构：

[1] HUS Helsinki Univ Hosp, Jorvi Hosp, Dept Internal Med, Espoo, Finland

[2] Univ Helsinki, Helsinki, Finland

[3] Aalto Univ, Espoo, Finland

[4] HUS Helsinki Univ Hosp, Dept Neurol, Helsinki, Finland

[5] Univ Eastern Finland, Kuopio, Finland

[6] Turku Univ Hosp, Turku, Finland

[7] Univ Turku, Turku, Finland

[8] Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland

[9] Univ Helsinki, Individualized Drug Therapy Res Program, Helsinki, Finland

[10] Helsinki Univ Hosp, HUS Diagnost Ctr, Dept Clin Pharmacol, Helsinki, Finland

[11] Kuopio Univ Hosp, Heart Ctr, Kuopio, Finland

[12] HUS Helsinki Univ Hosp, Jorvi Hosp, Dept Internal Med, HUS, PL 800,Turuntie 150, Espoo 00029, Finland

来源：

ANNALS OF MEDICINE | 2024年 / 56卷 / 01期

关键词：

Atrial fibrillation; oral anticoagulation; direct oral anticoagulant; warfarin; stroke; real world data; NORMALIZED RATIO CONTROL; STROKE PREVENTION; SAFETY; DABIGATRAN; APIXABAN; QUALITY; METAANALYSIS; EFFICACY; RIVAROXABAN; RISK;

D O I：

10.1080/07853890.2024.2364825

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundLittle is known how individual time-in-therapeutic-range (TTR) impacts the effectiveness and safety of warfarin therapy compared to direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF).ObjectiveTo compare the effectiveness and safety of standard dose DOACs to warfarin in patients with AF, while categorizing warfarin treated patients into quartiles based on their individual TTR.Materials and methodsWe conducted a nationwide study including all patients with new-onset AF between 2011 and 2018 in Finland. Hazard ratios (HR) were calculated using Cox regression analysis with the inverse probability of treatment weighted method to assess the risks of ischaemic stroke (IS), intracranial haemorrhage (ICH) and mortality for users of apixaban (n = 12,426), dabigatran (n = 4545), rivaroxaban (n = 12,950) and warfarin (n = 43,548).ResultsThe median TTR for warfarin users was 72%. Compared to the second best TTR quartile (reference), the risk of IS was higher in the two poorest TTR quartiles, and lower in the best TTR quartile and on rivaroxaban [2.35 (95% confidence interval, 1.85-2.85), 1.44 (1.18-1.75), 0.60 (0.47-0.77) and 0.72 (0.56-0.92)]. These differences were non-significant for apixaban and dabigatran. HR of ICH was 6.38 (4.88-8.35) and 1.87 (1.41-2.49) in the two poorest TTR groups, 1.44 (1.02-1.93) on rivaroxaban, and 0.58 (0.40-0.85) in the best TTR group compared to the reference group. Mortality was higher in the two poorest TTR groups and lowest in the best TTR group.ConclusionsThe outcome was unsatisfactory in the two lowest TTR quartiles - in half of the patients treated with warfarin. The differences between the high TTR groups and standard dose DOACs were absent or modest.

引用

页数：12