Why the study?
Chronic anticoagulant therapy with VKA is suboptimal among patients with AF, raising the question of whether a history of systemic embolism leads to better INR control.
Does a history of systemic embolism improve INR control in patients with atrial fibrillation on vitamin K antagonists?
Does a history of systemic embolism improve INR control in patients with atrial fibrillation on vitamin K antagonists?
Patients with AF and a history of systemic embolism have poorer INR control on VKA therapy, suggesting they may be better candidates for NOACs.
Answers are grounded in this paper and cite their sources.
AF patients with prior embolism had poorer INR control on VKA; leaves open preferential NOAC benefit, needing RCTs.
Among patients with AF chronic anticoagulant therapy with vitamin K antagonists (VKA) is suboptimal. Unfortunately, history of thromboembolic events did not cause better international normalized ratio (INR) control. Patients with a history of systemic embolism and very high risk for thromboembolic complications more often had INR below the therapeutic range than the rest of the patients with AF. It can be partly explained by the fact that patients with very high thromboembolic risk at the same time usually have a high risk of bleeding. We may assume that patients with multiple factors associated with inadequate INR may not be ideal candidates for VKA therapy. These patients should be possibly considered for non-vitamin K antagonist oral anticoagulants (NOACs). Further efforts should be made in Poland to improve the quality of antithrombotic care in patients with AF treated with VKA.
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Tomaszuk−Kazberuk et al. (2019) studied this question.
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