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J Cardiol. 2014 Aug;64(2):127-32. doi: 10.1016/j.jjcc.2013.11.015. Epub 2014 Jan 17.

Long-term PT-INR levels and the clinical events in the patients with non-valvular atrial fibrillation: a special reference to low-intensity warfarin therapy.

Author information

1
Tachikawa General Hospital, Cardiovascular Center, Nagaoka, Japan; Tokyo Medical University, Department of Cardiology, Tokyo, Japan.
2
Tachikawa General Hospital, Cardiovascular Center, Nagaoka, Japan.
3
Tachikawa General Hospital, Neurosurgery, Nagaoka, Japan.
4
Tachikawa General Hospital, Hematology, Nagaoka, Japan.
5
Tokyo Medical University, Department of Cardiology, Tokyo, Japan.
6
Tachikawa Medical Center, Research and Development, Nagaoka, Japan. Electronic address: aizaways@med.niigata-u.ac.jp.

Abstract

BACKGROUND:

Anticoagulation therapy is essential in atrial fibrillation (AF), and in Japan, less intense control is popular.

PURPOSE:

To assess the efficacy and safety with a special reference to low intensity warfarin therapy.

SUBJECTS AND METHODS:

In 488 out of 508 patients with non-valvular AF, prothrombin time-international normalized ratio (PT-INR) was kept at 1.6-2.59, and they were followed for 49.5 months: 2098 person-years. The mean age was 73.7±9.9 years and 62% were male. The patients were divided by age: ≥70 years and <70 years, and by the intensity of warfarin therapy: PT-INR at 1.6-1.99 and at 2.0-2.59, respectively. The clinical data and event rates, ischemic stroke and major bleeding, were compared among the subgroups.

RESULTS:

Heart failure, previous stroke, and higher CHADS2 score were more often reported in patients ≥70 years while males were involved more often as younger patients. A total of 166 of 339 patients ≥70 years and 69 of 149 patients <70 years belonged to the low intensity group. Ischemic stroke and major bleeding occurred in 1.47%/year and 1.27%/year, respectively but there was no difference between the two age groups and between the two intensities of warfarin therapy. Time in therapeutic range was a predictor for ischemic stroke. A fall of PT-INR to <1.6 was found in 41.9% with ischemic stroke and a rise >2.61 in 40.0% with major bleeding at the time of the events. Blunt trauma and concomitant use of antiplatelets were risks for intracranial hemorrhage in the patients ≥70 years.

CONCLUSIONS:

The event rates were similar between the low- (1.6-1.99) and high- (2.0-2.59) intensity warfarin therapy groups in aged patients: <70 years and ≥70 years. Time in therapeutic range and a transient fall or rise in PT-INR were risks for clinical events. Blunt head trauma and concomitant use of antiplatelets were risks for intracranial hemorrhage.

KEYWORDS:

Anticoagulants; Atrial fibrillation; Stroke; Warfarin

PMID:
24440439
DOI:
10.1016/j.jjcc.2013.11.015
[Indexed for MEDLINE]
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