Mohd, Fahmi Nazrin
(2015)
Percentage of time in therapeutic range and proportion of thromboembolic event in nonvalvular atrial fibrillation patient on warfarin.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background
Atrial fibrillation ( AF ) is the most common sustained cardiac arrhythmia. The use of
warfarin reduces the rate of ischemic stroke in patients with nonvalvular AF, but requires
frequent monitoring and dose adjustment. Target INR are frequently not achieved, and the
risk of thrombosis, bleeding and death may be related to INR control.
Methods :
We analyzed the relationship between the INR control and the proportion of thromboembolic
event, bleeding and clinical factors associated with time in therapeutic range ( TTR ) , among
73 patients with nonvalvular atrial fibrillation. Patient were divided into 2 groups ( those
with good control TTR ≥ 60% and those with poor control TTR < 60 % ), according to the
percentage time with an INR of 2.0 to 3.0. Outcomes were compared according to INR
control. The main outcome measures were thrombotic event, and bleeding.
Result :
The mean TTR in Kelantan patient is 40% with poor control group had higher rates of
bleeding ( odds ratio, 5.01; 95% CI 1.30 to 19.39; p = 0.02 ) compared with the good control
group. Several clinical factors were identified incliding triglyceride ( odds ratio, 10.60;95%
CI 1.64 to 68.39; p = 0.013 ), type of AF – permanent ( odds ratio, 6.81; 95% CI 1.22 to
38.11; p = 0.029 ) and bleeding ( odds ratio, 9.98; 95% CI 1.65 to 60.22; p = 0.012 )
significantly associated with TTR < 60%.
Conclusion :
In patient with nonvalvular atrial fibrillation taking warfarin, the risk of bleeding
is related to poor control of TTR. Good INR control is important to improve patient
outcome.
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