I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy; Institute for Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom.
I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
Am Heart J. 2018 Jun;200:32-36. doi: 10.1016/j.ahj.2018.03.004. Epub 2018 Mar 10.
Vitamin K antagonists (VKAs) reduce cardiovascular events (CVEs) in atrial fibrillation (AF) when a time in therapeutic range (TiTR) >70% is achieved. Factors affecting the time to achieve the TR (TtTR) are unknown.
Prospective observational study including 1,406 nonvalvular AF patients starting VKAs followed for a mean of 31.3months (3,690 patient/year); TiTR, TtTR, and SAMe-TTR score were calculated, and CVEs were recorded.
Median TtTR was 8.0days (interquartile range 5.0-18.0). Patients with high TtTR (ie, >75th percentile) were more likely to be in AF than in sinus rhythm at entry (odds ratio [OR]: 1.423, P=.011). Median TiTR was 60.0%; low TiTR (below median) was associated with SAMe-TTR score (OR: 1.175, P=.001), high TtTR (>75th percentile, OR: 1.357, P=.017), and number of international normalized ratio checks (OR: 0.998, P=.049). We recorded 113 CVEs (3.1%/y), with a higher rate seen in patients with TtTR >75th percentile compared to those below (log-rank test, P=.006). A multivariable Cox regression analysis showed that SAMe-TTR score (hazard ratio [HR]: 1.331, P<.001), TtTR >75th percentile (HR: 1.505, P=.047), TiTR <70% (HR: 1.931, P=.004), number of international normalized ratio checks (HR: 0.988, P<.001), digoxin (HR: 1.855, P=.008), and proton-pump inhibitors (HR: 0.452, P<.001) were independently associated with CVEs.
High TtTR is associated with poorer long-term quality of VKAs therapy. Patients with TtTR >18days or with high SAMe-TTR score should be considered for treatment with non-vitamin K oral anticoagulants.
维生素 K 拮抗剂（VKA）可降低心房颤动（AF）患者的心血管事件（CVE），当达到治疗范围时间（TiTR）>70%时。影响达到 TR 时间（TtTR）的因素尚不清楚。
前瞻性观察研究包括 1406 例开始使用 VKA 的非瓣膜性 AF 患者，平均随访 31.3 个月（3690 例/年）；计算 TiTR、TtTR 和 SAMe-TTR 评分，并记录 CVE。
中位 TtTR 为 8.0 天（四分位距 5.0-18.0）。TtTR 较高（即>第 75 百分位）的患者在入组时更可能处于 AF 而不是窦性心律（优势比[OR]：1.423，P=.011）。中位 TiTR 为 60.0%；TiTR 较低（低于中位数）与 SAMe-TTR 评分相关（OR：1.175，P=.001）、TtTR 较高（>第 75 百分位，OR：1.357，P=.017）和国际标准化比值检查次数（OR：0.998，P=.049）。我们记录了 113 例 CVE（3.1%/年），与 TtTR >第 75 百分位的患者相比，TtTR 较高的患者发生率更高（对数秩检验，P=.006）。多变量 Cox 回归分析显示，SAMe-TTR 评分（风险比[HR]：1.331，P<.001）、TtTR >第 75 百分位（HR：1.505，P=.047）、TiTR <70%（HR：1.931，P=.004）、国际标准化比值检查次数（HR：0.988，P<.001）、地高辛（HR：1.855，P=.008）和质子泵抑制剂（HR：0.452，P<.001）与 CVE 独立相关。
TtTR 较高与 VKAs 治疗的长期质量较差相关。TtTR >18 天或 SAMe-TTR 评分较高的患者应考虑使用非维生素 K 口服抗凝剂。
