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KMID : 1130620170130030273
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Journal of Clinical Neurology
2017 Volume.13 No. 3 p.273 ~ p.280
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Quality of Anticoagulation with Warfarin in Korean Patients with Atrial Fibrillation and Prior Stroke: A Multicenter Retrospective Observational Study
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Hong Keun-Sik
Kim Yang-Ki
Bae Hee-Joon
Nam Hyo-Suk
Kwon Sun-U.
Bang Oh-Young
Cha Jae-Kwan
Yoon Byung-Woo
Rha Joung-Ho
Lee Byung-Chul
Park Jong-Moo
Park Man-Seok
Lee Jun
Choi Jay-Chol
Kim Dong-Eog
Lee Kyung-Bok
Park Tai-Hwan
Lee Ji-Sung
Kim Seong-Eun
Lee June-Young
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Abstract
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Background and Purpose: The quality of anticoagulation is critical for ensuring the benefit of warfarin, but this has been less well studied in Korean ischemic stroke patients with atrial fibrillation (AF).
Methods: This study retrospectively analyzed the data of patients who had an AF-related ischemic stroke and were treated with long-term warfarin therapy in 16 Korean centers. The quality of warfarin therapy was primarily assessed by the time in therapeutic range [TTR; international normalized ratio (INR), 2.0?3.0] and additionally by the proportion of INR values within the therapeutic range.
Results: The long-term warfarin-treated cohort comprised 1,230 patients. They were aged 70.1±9.7 years (mean±SD), 42.5% were female, and their CHA2DS2-VASc score was 4.75±1.41. The TTR analysis included 33,941 INR measurements for 27,487 months: per patients, 27.6 (SD, 22.4) INR measurements for 22.4 (SD, 12.9) months. The mean TTR of individual patients was 49.1% (95% confidence interval, 47.9?50.3%), and the TTR quartiles were <34.5, 34.5?49.1, 49.1?64.5%, and >64.5%. None of the 16 centers achieved a mean TTR of >60%. Of all INR measurements, 44.6% were within the therapeutic range, 41.7% were <2.0, and 13.7% were >3.0.
Conclusions: In Korean ischemic stroke patients who had AF, the quality of warfarin therapy was low and might be inadequate to effectively prevent recurrent stroke or systemic embolism.
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KEYWORD
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warfarin, quality, time in therapeutic range, atrial fibrillation, seconadry stroke prevention
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