ISSN 1671-5411 CN 11-5329/R
Volume 17 Issue 10
Nov.  2020
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Rungroj Krittayaphong, Rapeephon Kunjara-Na-Ayudhya, Pornchai Ngamjanyaporn, Smonporn Boonyaratavej, Chulalak Komoltri, Ahthit Yindeengam, Piyamitr Sritara, Gregory Y. H. Lip, for the COOL-AF Investigators. Optimal INR level in elderly and non-elderly patients with atrial fibrillation receiving warfarin: a report from the COOL-AF nationwide registry in Thailand. J Geriatr Cardiol 2020; 17(10): 612-620. doi: 10.11909/j.issn.1671-5411.2020.10.004
Citation: Rungroj Krittayaphong, Rapeephon Kunjara-Na-Ayudhya, Pornchai Ngamjanyaporn, Smonporn Boonyaratavej, Chulalak Komoltri, Ahthit Yindeengam, Piyamitr Sritara, Gregory Y. H. Lip, for the COOL-AF Investigators. Optimal INR level in elderly and non-elderly patients with atrial fibrillation receiving warfarin: a report from the COOL-AF nationwide registry in Thailand. J Geriatr Cardiol 2020; 17(10): 612-620. doi: 10.11909/j.issn.1671-5411.2020.10.004

Optimal INR level in elderly and non-elderly patients with atrial fibrillation receiving warfarin: a report from the COOL-AF nationwide registry in Thailand

doi: 10.11909/j.issn.1671-5411.2020.10.004
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  • Corresponding author: Rungroj Krittayaphong, MD, Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. E-mail: rungroj.kri@mahidol.ac.th
  • Received Date: 2020-07-08
  • Accepted Date: 2020-10-12
  • Rev Recd Date: 2020-08-20
  • Available Online: 2020-10-28
  • Publish Date: 2020-10-28
  •  Background Asian population are at increased risk of bleeding during the warfarin treatment, so the recommended optimal international normalized ratio (INR) level may be lower in Asians than in Westerners. The aim of this prospective multicenter study was to determine the optimal INR level in Thai patients with non-valvular atrial fibrillation (NVAF). Methods Patients with NVAF who were on warfarin for stroke prevention were recruited from 27 hospitals in the nationwide COOL-AF registry in Thailand. We collected demographic data, medical history, risk factors for stroke and bleeding, concomitant disease, electrocardiogram and laboratory data including INR and antithrombotic medications. Outcome measurements included ischemic stroke/transient ischemic attack (TIA) and major bleeding. Optimal INR level was assessed by the calculation of incidence density for six INR ranges (< 1.5, 1.5–1.99, 2–2.49, 2.5–2.99, 3–3.49, and ≥ 3.5). Results A total of 2, 232 patients were included. The mean age of patients was 68.5 ± 10.6 years. The mean follow-up duration was 25.7 ± 10.6 months. There were 63 ischemic stroke/TIA and 112 major bleeding events. The lowest prevalence of ischemic stroke/TIA and major bleeding events occurred within the INR range of 2.0–2.99 for patients < 70 years and 1.5–2.99 for patients ≥ 70 years. Conclusions The INR range associated with the lowest risk of ischemic stroke/TIA and bleeding in the Thai population was 2.0–2.99 for patients < 70 years and 1.5–2.99 for patients ≥ 70 years. The rates of major bleeding and ischemic stroke/TIA were both higher than the rates reported in Western population.
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  • [1]
    Lip GYH, Brechin CM, Lane DA. The global burden of atrial fibrillation and stroke: a systematic review of the epidemiology of atrial fibrillation in regions outside North America and Europe. Chest 2012; 142: 1489-1498. doi: 10.1378/chest.11-2888
    [2]
    Tse HF, Wang YJ, Ahmed Ai-Abdullah M, et al. Stroke prevention in atrial fibrillation: an Asian stroke perspective. Heart Rhythm 2013; 10: 1082-1088. doi: 10.1016/j.hrthm.2013.03.017
    [3]
    Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37: 2893-2962. doi: 10.1093/eurheartj/ehw210
    [4]
    Chiang CE, Okumura K, Zhang S, et al. 2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation. J Arrhythm 2017; 33: 345-367. doi: 10.1016/j.joa.2017.05.004
    [5]
    Lip GYH, Banerjee A, Boriani G, et al. Antithrombotic therapy for atrial fibrillation: CHEST guideline and expert panel report. Chest 2018; 154: 1121-1201. doi: 10.1016/j.chest.2018.07.040
    [6]
    January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2019; 74: 104-132. doi: 10.1016/j.jacc.2019.01.011
    [7]
    Yang X, Li Z, Zhao X, et al. Use of warfarin at discharge among acute ischemic stroke patients with non-valvular atrial fibrillation in China. Stroke 2016; 47: 464-470. doi: 10.1161/STROKEAHA.115.011833
    [8]
    Krittayaphong R, Winijkul A, Methavigul K, et al. Risk profiles and pattern of antithrombotic use in patients with non-valvular atrial fibrillation in Thailand: a multicenter study. BMC Cardiovasc Disord 2018; 18: 174. doi: 10.1186/s12872-018-0911-4
    [9]
    Dilokthornsakul P, Nathisuwan S, Krittayaphong R, et al. Cost-effectiveness analysis of non-vitamin K antagonist oral anticoagulants versus warfarin in Thai patients with non-valvular atrial fibrillation. Heart Lung Circ 2020; 29: 390-400. doi: 10.1016/j.hlc.2019.02.187
    [10]
    Shen AY, Yao JF, Brar SS, et al. Racial/ethnic differences in the risk of intracranial hemorrhage among patients with atrial fibrillation. J Am Coll Cardiol 2007; 50: 309-315. doi: 10.1016/j.jacc.2007.01.098
    [11]
    Chiang CE, Wang KL, Lip GY. Stroke prevention in atrial fibrillation: an Asian perspective. Thromb Haemost 2014; 111: 789-797. doi: 10.1160/TH13-11-0948
    [12]
    Lip G, Freedman B, De Caterina R, et al. Stroke prevention in atrial fibrillation: past, present and future. Comparing the guidelines and practical decision-making. Thromb Haemost 2017; 117: 1230-1239. doi: 10.1160/TH16-11-0876
    [13]
    Wallentin L, Yusuf S, Ezekowitz MD, et al. Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial. Lancet 2010; 376: 975-983. doi: 10.1016/S0140-6736(10)61194-4
    [14]
    JCS joint working group. Guidelines for pharmacotherapy of atrial fibrillation (JCS 2013). Circ J 2014; 78: 1997-2021. doi: 10.1253/circj.CJ-66-0092
    [15]
    Chen KP, Huang CX, Huang DJ, et al. Anticoagulation therapy in Chinese patients with non-valvular atrial fibrillation: a prospective, multi-center, randomized, controlled study. Chin Med J (Engl) 2012; 125: 4355-4360.
    [16]
    Rosendaal FR, Cannegieter SC, van der Meer FJ, et al. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost 1993; 69: 236-239. doi: 10.1055/s-0038-1651587
    [17]
    Schulman S, Kearon C, Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 2005; 3: 692-694. doi: 10.1111/j.1538-7836.2005.01204.x
    [18]
    Inoue H, Okumura K, Atarashi H, et al. Target international normalized ratio values for preventing thromboembolic and hemorrhagic events in Japanese patients with non-valvular atrial fibrillation: results of the J-RHYTHM registry. Circ J 2013; 77: 2264-2270. doi: 10.1253/circj.CJ-13-0290
    [19]
    Haas S, Ten Cate H, Accetta G, et al. Quality of vitamin K antagonist control and 1-year outcomes in patients with atrial fibrillation: a global perspective from the GARFIELD-AF registry. PLoS One 2016; 11: e0164076. doi: 10.1371/journal.pone.0164076
    [20]
    Poli D, Antonucci E, Dentali F, et al. Recurrence of ICH after resumption of anticoagulation with VK antagonists: CHIRONE study. Neurology 2014; 82: 1020-1026. doi: 10.1212/WNL.0000000000000245
    [21]
    Oh S, Goto S, Accetta G, et al. Vitamin K antagonist control in patients with atrial fibrillation in Asia compared with other regions of the world: real-world data from the GARFIELD- AF registry. Int J Cardiol 2016; 223: 543-547. doi: 10.1016/j.ijcard.2016.08.236
    [22]
    Proietti M, Senoo K, Lane DA, et al. Major bleeding in patients with non-valvular atrial fibrillation: impact of time in therapeutic range on contemporary bleeding risk scores. Sci Rep 2016; 6: 24376. doi: 10.1038/srep24376
    [23]
    Kakkar AK, Mueller I, Bassand JP, et al. Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry. PLoS One 2013; 8: e63479. doi: 10.1371/journal.pone.0063479
    [24]
    Hylek EM, Skates SJ, Sheehan MA, et al. An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation. N Engl J Med 1996; 335: 540-546. doi: 10.1056/NEJM199608223350802
    [25]
    Yamaguchi T. Optimal intensity of warfarin therapy for secondary prevention of stroke in patients with nonvalvular atrial fibrillation: a multicenter, prospective, randomized trial. Japanese Nonvalvular Atrial Fibrillation-Embolism Secondary Prevention Cooperative Study Group. Stroke 2000; 31: 817-821. doi: 10.1161/01.STR.31.4.817
    [26]
    Suzuki S, Yamashita T, Kato T, et al. Incidence of major bleeding complication of warfarin therapy in Japanese patients with atrial fibrillation. Circ J 2007; 71: 761-765. doi: 10.1253/circj.71.761
    [27]
    Yasaka M, Minematsu K, Yamaguchi T. Optimal intensity of international normalized ratio in warfarin therapy for secondary prevention of stroke in patients with non-valvular atrial fibrillation. Intern Med 2001; 40: 1183-1188. doi: 10.2169/internalmedicine.40.1183
    [28]
    Bassand JP, Accetta G, Camm AJ, et al. Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF. Eur Heart J 2016; 37: 2882-2889. doi: 10.1093/eurheartj/ehw233
    [29]
    Lopes RD, Guimarães PO, Kolls BJ, et al. Intracranial hemorrhage in patients with atrial fibrillation receiving anticoagulation therapy. Blood 2017; 129: 2980-2987. doi: 10.1182/blood-2016-08-731638
    [30]
    Ogawa H, Hamatani Y, DoiK, et al. Sex-related differences in the clinical events of patients with atrial fibrillation: the Fushimi AF registry. Circ J 2017; 81: 1403-1410. doi: 10.1253/circj.CJ-17-0071
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