Mohammed Shaban, Aljundi Amer H S, Kasem Mohamed, Alhashemi Mohammed, El-Menyar Ayman
Department of Clinical Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
J Adv Pharm Technol Res. 2017 Jan-Mar;8(1):14-18. doi: 10.4103/2231-4040.197370.
There is a limited knowledge about the predictors of anticoagulation control in patients with nonvalvular atrial fibrillation (NVAF). Furthermore, few reports addressed the role of time in therapeutic range (TTR) that could reflect the safety and efficacy of anticoagulation therapy. We aimed to assess factors that affect the quality of anticoagulation therapy utilizing TTR in patients with NVAF. A retrospective observational study was conducted for patients with NVAF who were maintained on warfarin >6 months at a tertiary cardiac care hospital. Patients were categorized according to the TTR status (≥65% vs. <65%). A total of 241 eligible patients were identified. A high-quality anticoagulation based on TTR values ≥65% was found in 157 (65.1%) patients; the remaining (34.9%) patients represented the low-quality anticoagulation group (TTR <65%). Demographics and clinical characteristics were comparable in the two TTR groups. Both groups were comparable in terms of warfarin dose and medications use. When compared to patients with high-quality anticoagulation, patients in the low-quality anticoagulation group were more likely to seek outpatient warfarin clinic visits more frequently (22.3 ± 5.5 vs. 18 ± 4.4, = 0.001) and to have higher rate of polypharmacy (57.1% vs. 42%, = 0.03). Of note, patients in both groups had similar major bleeding events ( = 0.41). After adjusting for age and sex, polypharmacy use was a predictor of poor coagulation control (odds ratio = 1.89, 95% confidence interval: 1.03-3.33; = 0.03). In NVAF patients, TTR is generally high in our cohort. Patients with polypharmacy and frequent clinic visits have lower TTR. High-quality oral anticoagulation could be achieved through optimizing TTR without a significant risk of major bleeding.
关于非瓣膜性心房颤动（NVAF）患者抗凝控制的预测因素，目前了解有限。此外，很少有报告涉及能反映抗凝治疗安全性和有效性的治疗时间范围（TTR）的作用。我们旨在评估利用TTR来影响NVAF患者抗凝治疗质量的因素。在一家三级心脏护理医院，对服用华法林超过6个月的NVAF患者进行了一项回顾性观察研究。根据TTR状态（≥65%与<65%）对患者进行分类。共确定了241例符合条件的患者。157例（65.1%）患者的TTR值≥65%，实现了高质量抗凝；其余（34.9%）患者为低质量抗凝组（TTR<65%）。两个TTR组的人口统计学和临床特征具有可比性。两组在华法林剂量和药物使用方面相当。与高质量抗凝患者相比，低质量抗凝组患者更频繁地寻求门诊华法林诊所就诊（22.3±5.5 vs. 18±4.4，P = 0.001），且多药合用率更高（57.1% vs. 42%，P = 0.03）。值得注意的是，两组患者的主要出血事件相似（P = 0.41）。在调整年龄和性别后，多药合用是凝血控制不佳的一个预测因素（比值比 = 1.89，95%置信区间：1.03 - 3.33；P = 0.03）。在我们的队列中，NVAF患者的TTR总体较高。多药合用且频繁就诊的患者TTR较低。通过优化TTR可实现高质量口服抗凝，且无重大出血的显著风险。
