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KMID : 0368120200500020163
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Korean Circulation Journal
2020 Volume.50 No. 2 p.163 ~ p.175
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Impact of Anticoagulation Intensity in Korean Patients with Atrial Fibrillation: Is It Different from Western Population?
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Lee Ki-Hong
Cho Jeong-Gwan
Lee Nu-Ri
Cho Kyung-Hoon
Jeong Hyung-Ki
Park Hyuk-Jin
Kim Yong-Cheol
Cho Jae-Yeong
Kim Min-Chul
Sim Doo-Sun
Yoon Hyun-Ju
Yoon Nam-Sik
Kim Kye-Hun
Hong Young-Joon
Park Hyung-Wook
Ahn Young-Keun
Jeong Myung-Ho
Park Jong-Chun
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Abstract
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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.
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KEYWORD
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Warfarin, Prothrombin time, Atrial fibrillation, Thromboembolism, Safety
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