Defining time in therapeutic range for busy clinicians: frequency of dose changes is a good surrogate marker to identify patients with suboptimal anticoagulation with warfarin.

Abirami Vijenthira; Gregoire Le Gal; Lana A Castellucci; Marc Carrier

Defining time in therapeutic range for busy clinicians: frequency of dose changes is a good surrogate marker to identify patients with suboptimal anticoagulation with warfarin.

Abirami Vijenthira ^{1, 2} Gregoire Le Gal ^{3, 4} Lana A Castellucci ¹ Marc Carrier ^{1, 5, 6, *}

* Auteur correspondant

1 Thrombosis Program

2 Département de médecine

3 CIC - Brest - Centre d'Investigation Clinique

4 GETBO - Groupe d'Etude de la Thrombose de Bretagne Occidentale

5 Clinical Epidemiology Unit

6 IRHM - Institut de Recherche de l'Hopital Montfort [Ottawa]

Abstract : Patients on warfarin with sub-optimal time-in-therapeutic-range (TTR) are more likely to have adverse events. Target-specific oral anticoagulants (TSOACs) are approved and can be used as an alternative to warfarin for a number of indications. Further, the efficacy and safety profiles of the TSOACs compared to warfarin are more favourable when the TTR is ≤65% for certain indications. We aimed to determine simple, sensitive and specific diagnostic tools to identify TTR ≤ 65% during the initial three months of warfarin therapy. A cross-sectional study including patients newly initiated on warfarin without any interruption for three months was conducted. TTR was calculated using the Rosendaal method. Patients were stratified by TTR (≤ 65% or >65%). Number of INR measurements, dose changes and INR measurements of ≤ 1.7 or ≥ 4.0 were evaluated as potential diagnostic tools to identify TTR ≤ 65%. 670 patients were included. The most common indication for anticoagulation was venous thromboembolism. The mean TTR in the first three months was 68 ± 21% (Range: 10 to 100%). Three or more dose changes identified TTR ≤ 65% and demonstrated a sensitivity and specificity of 90% (95%CI 86 to 93%) and 56% (95%CI 51 to 61%), respectively. Three or more INR measurements of ≤ 1.7 during the initial three months of anticoagulation showed a sensitivity and specificity of 37% (95%CI 32 to 43%) and 98% (95%CI 96 to 99%), respectively. Three or more dose changes and three or more INR measurements of ≤ 1.7 could identify patients with a TTR ≤ 65% in the first three months of warfarin therapy.

Keywords : Venous thrombosis Warfarin Acenocoumarol

Type de document :

Article dans une revue

Thrombosis Research, Elsevier, 2014, 134 (3), pp.584-586

Domaine :

Sciences du Vivant [q-bio]

Sciences du Vivant [q-bio] / Médecine humaine et pathologie

Liste complète des métadonnées

http://hal.univ-brest.fr/hal-01111298
Contributeur : Catherine Bertignac <>
Soumis le : vendredi 30 janvier 2015 - 09:50:03
Dernière modification le : mercredi 10 janvier 2018 - 14:42:02

Defining time in therapeutic range for busy clinicians: frequency of dose changes is a good surrogate marker to identify patients with suboptimal anticoagulation with warfarin.

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Defining time in therapeutic range for busy clinicians: frequency of dose changes is a good surrogate marker to identify patients with suboptimal anticoagulation with warfarin.

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