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June 24, 2014Thrombosis JournalOpen Access

Quality of vitamin K antagonist control and outcomes in atrial fibrillation patients: a meta-analysis and meta-regression

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Why the study?

What is the quality of vitamin K antagonist control and its relationship with adverse outcomes in patients with atrial fibrillation?

Population

Adult patients with atrial fibrillation receiving dose-adjusted vitamin K antagonists for ≥3 months. 95…

Design

Meta-analysis

Key result

Patients with atrial fibrillation receiving vitamin K antagonists spent only 61% of their time in the therapeutic INR range, with 57% of thromboembolic events occurring at an INR <2.0.

Authors

EMElizabeth S. MearnsCWC Michael WhiteCKChristine G. Kohn

Discussion

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Overview

Poor VKA control in AF heightens thromboembolic risk; confirms subtherapeutic INR drives events and supports optimized monitoring or NOAC preference.

Study Design

Type

Meta-Analysis

Multicenter

Yes

Structured PICO

What is the quality of vitamin K antagonist control and its relationship with adverse outcomes in patients with atrial fibrillation?

P
Population
Adult patients (≥18 years of age) with atrial fibrillation receiving dose-adjusted vitamin K antagonists (target INR 2.0 to 3.0) for ≥3 months. 95 articles included.
I
Intervention
Adjusted-dose vitamin K antagonists (VKAs)
O
Outcome
Time spent in therapeutic range (TTR), proportion of international normalized ratio (INR) measurements in range (PINRR), and INR measurement coinciding with thromboembolic or hemorrhagic eventssurrogate

Patients with atrial fibrillation on vitamin K antagonists frequently have INRs outside the therapeutic range, which is associated with increased risks of thromboembolism (INR <2.0) and hemorrhage (INR >3.0), particularly in community practice settings and VKA-naïve patients.

Limitations

  • Potential for publication bias and possibility of missed eligible articles
  • High degree of statistical heterogeneity among included studies
  • INR data was incomplete in 58% of the studies that reported adverse events
  • High statistical heterogeneity between groups (I² ≥97%)
  • Publication bias likely for the time below range analysis
  • INR data incomplete in 58% of studies reporting adverse events
  • 30% of studies used previously reported INRs up to 12 days prior to the adverse event

Cite This Study

Mearns et al. (2014) conducted a meta-analysis in Atrial fibrillation. Vitamin K antagonists was evaluated on Time spent in therapeutic range (TTR) (95% CI 59-62). Patients with atrial fibrillation receiving vitamin K antagonists spent only 61% of their time in the therapeutic INR range, with 57% of thromboembolic events occurring at an INR <2.0.

synapsesocial.com/papers/6a0846acab15ea61dee8c10chttps://doi.org/10.1186/1477-9560-12-14
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