Zawawi Nur Azyyati, Abdul Halim Zaki Izzati, Ming Long Chiau, Goh Hui Poh, Zulkifly Hanis Hanum
Department of Pharmacy Practice, Fakulti Farmasi, Universiti Teknologi MARA (UiTM), Bandar Puncak Alam, Malaysia.
Cardiology Therapeutics Research Group, Universiti Teknologi MARA, Bandar Puncak Alam, Malaysia.
Front Cardiovasc Med. 2021 Nov 16;8:736143. doi: 10.3389/fcvm.2021.736143. eCollection 2021.
Vitamin K antagonist such as warfarin reduces the risk of stroke in atrial fibrillation (AF) patients. Since warfarin has a narrow therapeutic index, its administration needs to be regularly monitored to avoid any adverse clinical outcomes such as stroke and bleeding. The quality of anticoagulation control with warfarin therapy can be measured by using time in therapeutic range (TTR). This review focuses on the prevalence of AF, quality of anticoagulation control (TTR) and adverse clinical outcome in AF patients within different ethnic groups receiving warfarin therapy for stroke prevention. A literature search was conducted in Embase and PubMed using keywords of "prevalence," "atrial fibrillation," "stroke prevention," "oral anticoagulants," "warfarin," "ethnicities," "race" "time in therapeutic range," "adverse clinical outcome," "stroke, bleeding." Articles published by 1st February 2020 were included. Forty-one studies were included in the final review consisting of AF prevalence ( = 14 studies), time in therapeutic range ( = 18 studies), adverse clinical outcome ( = 9 studies) within different ethnic groups. Findings indicate that higher prevalence of AF but better anticoagulation control among the Whites as compared to other ethnicities. Of note, non-whites had higher risk of strokes and bleeding outcomes while on warfarin therapy. Addressing disparities in prevention and healthcare resource allocation could potentially improve AF-related outcomes in minorities.
维生素K拮抗剂如华法林可降低心房颤动（AF）患者中风的风险。由于华法林的治疗指数较窄，其用药需要定期监测，以避免出现任何不良临床后果，如中风和出血。华法林治疗的抗凝控制质量可用治疗范围内时间（TTR）来衡量。本综述聚焦于接受华法林治疗以预防中风的不同种族AF患者中AF的患病率、抗凝控制质量（TTR）及不良临床后果。在Embase和PubMed数据库中进行了文献检索，使用的关键词有“患病率”“心房颤动”“中风预防”“口服抗凝剂”“华法林”“种族”“治疗范围内时间”“不良临床后果”“中风、出血”。纳入了2020年2月1日前发表的文章。最终综述纳入了41项研究，包括不同种族中的AF患病率（=14项研究）、治疗范围内时间（=18项研究）、不良临床后果（=9项研究）。研究结果表明，与其他种族相比，白人中AF患病率较高，但抗凝控制较好。值得注意的是，非白人在接受华法林治疗时中风和出血后果的风险较高。解决预防和医疗资源分配方面的差异可能会改善少数族裔与AF相关的结局。
