Impact of Anticoagulation Intensity in Korean Patients with Atrial Fibrillation: Is It Different from Western Population?
- Author:
Ki Hong LEE
1
;
Jeong Gwan CHO
;
Nuri LEE
;
Kyung Hoon CHO
;
Hyung Ki JEONG
;
Hyukjin PARK
;
Yongcheol KIM
;
Jae Yeong CHO
;
Min Chul KIM
;
Doo Sun SIM
;
Hyun Ju YOON
;
Namsik YOON
;
Kye Hun KIM
;
Young Joon HONG
;
Hyung Wook PARK
;
Youngkeun AHN
;
Myung Ho JEONG
;
Jong Chun PARK
Author Information
- Publication Type:Original Article
- Keywords: Warfarin; Prothrombin time; Atrial fibrillation; Thromboembolism; Safety
- MeSH: Atrial Fibrillation; Follow-Up Studies; Hemorrhage; Humans; International Normalized Ratio; Prothrombin Time; Risk Reduction Behavior; Stroke; Thromboembolism; Warfarin
- From:Korean Circulation Journal 2020;50(2):163-175
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND AND OBJECTIVES: Although anticoagulation with warfarin is recommended as an international normalized ratio (INR) of prothrombin time between 2.0 and 3.0 and mean time in the therapeutic range (TTR) ≥70%, little has been proven that universal criteria might be suitable in Korean atrial fibrillation (AF) patients.METHODS: We analyzed 710 patients with non-valvular AF who took warfarin. INR value and clinical outcomes were assessed during 2-year follow-up. Intensity of anticoagulation was assessed as mean INR value and TTR according to target INR range. Primary net-clinical outcome was defined as the composite of new-onset stroke and major bleeding. Secondary net-clinical outcome was defined as the composite of new-onset stroke, major bleeding and death.RESULTS: Thromboembolism was significantly decreased when mean INR was over 1.6. Major bleeding was significantly decreased when TTR was over 70% and mean INR was less than 2.6. Mean INR 1.6–2.6 significantly reduced thromboembolism (adjusted hazard ratio [HR], 0.40; 95% confidence interval [CI], 0.19–0.85), major bleeding (HR, 0.43; 95% CI, 0.23–0.81), primary (HR, 0.50; 95% CI, 0.29–0.84) and secondary (HR, 0.45; 95% CI, 0.28–0.74) net-clinical outcomes, whereas mean INR 2.0–3.0 did not. Simultaneous satisfaction of mean INR 1.6–2.6 and TTR ≥70% was associated with significant risk reduction of major bleeding, primary and secondary net-clinical outcomes.CONCLUSIONS: Mean INR 1.6–2.6 was better than mean INR 2.0–3.0 for the prevention of thromboembolism and major bleeding. However, INR 1.6–2.6 and TTR ≥70% had similar clinical outcomes to INR 2.0–3.0 and TTR ≥70% in Korean patients with non-valvular AF.
