Morgan Christopher Ll, McEwan Phil, Tukiendorf Andrzej, Robinson Paul A, Clemens Andreas, Plumb Jonathan M
Cardiff Research Consortium Ltd, University Hospital of Wales, Heath Park, Cardiff CF14 4UJ, UK.
Thromb Res. 2009 May;124(1):37-41. doi: 10.1016/j.thromres.2008.09.016. Epub 2008 Dec 4.
We aimed to determine the level of INR control associated with reduced stroke and mortality.
The study used a retrospective cohort design using linked inpatient, haematology and mortality data from Cardiff and the Vale of Glamorgan, UK. Anonymised patients admitted with a diagnosis of non-valvular atrial fibrillation (NVAF) were defined as warfarin or non-warfarin treated by number of repeated International Normalised Ratio (INR) tests. Warfarin treated patients (>5 INR tests) categorised as at moderate or high risk of stroke (CHADS2 score > or = 2) with varying levels of INR control were compared to those who did not receive warfarin treatment using Cox proportional hazards models controlling for age, sex and CHADS2 score. Outcome measures were time to stroke and mortality.
6,108 patients with NVAF were identified. 2,235 (36.6%) of these patients had five or more INR readings and of these 486 (21.7%) had CHADS2 score > or = 2. There was significant improvement in time to stroke event in those patients with INR control of greater than 70% of time in therapeutic range (2.0 to 3.0) compared with the non-warfarin treatment group. Overall survival was significantly improved for all warfarin treated groups with INR control of greater than 40% of time in range.
Patients with INR control of above 70% of time in range had a significantly reduced risk of stroke. Patient suitability for warfarin treatment should be continuously assessed based on their ability to maintain a consistently therapeutic INR.
我们旨在确定与降低中风和死亡率相关的国际标准化比值（INR）控制水平。
本研究采用回顾性队列设计，使用了来自英国加的夫和格拉摩根谷的住院患者、血液学和死亡率的关联数据。通过重复国际标准化比值（INR）检测次数，将确诊为非瓣膜性心房颤动（NVAF）的匿名患者定义为接受华法林治疗或未接受华法林治疗。使用Cox比例风险模型，对年龄、性别和CHADS2评分进行控制，将华法林治疗患者（>5次INR检测）中不同INR控制水平且中风中度或高度风险（CHADS2评分>或 = 2）的患者与未接受华法林治疗的患者进行比较。观察指标为中风时间和死亡率。
共识别出6108例NVAF患者。其中2235例（36.6%）患者有5次或更多次INR读数，其中486例（21.7%）CHADS2评分>或 = 2。与非华法林治疗组相比，INR在治疗范围内（2.0至3.0）的时间控制大于70%的患者，中风事件发生时间有显著改善。对于所有INR在范围内的时间控制大于40%的华法林治疗组，总体生存率有显著提高。
INR在范围内的时间控制超过70%的患者中风风险显著降低。应根据患者维持持续治疗性INR的能力，持续评估其对华法林治疗的适用性。
