Why the study?
The pattern of anticoagulation and its impact on outcomes after venous thromboembolism in clinical practice were not well characterized.
Does a higher time spent within therapeutic range for INR reduce VTE recurrence and mortality in patients with venous thromboembolism?
Cohort (n=184,359)
Does a higher time spent within therapeutic range for INR reduce VTE recurrence and mortality in patients with venous thromboembolism?
Relative Risk: 0.5 (95% CI 0.39–0.63)
Maintaining a high time in therapeutic range (≥70%) for INR significantly reduces the risk of VTE recurrence and VTE-related death in real-world clinical practice.
High TTR associated with lower VTE recurrence in cohort data; leaves open whether optimizing INR control improves outcomes in trials.
Introduction: The objective of this study was to evaluate the pattern of anticoagulation after venous thromboembolism (VTE) in actual clinical practice. Material and Methods: This study used the General Practice Research Database. Individuals aged 18+ years with VTE were matched to 3 controls. Results: Of the 46 335 patients with VTE and 138 024 controls, 70.2% of cases and 86.6% of controls had no obvious risk factors. The mortality risk was increased substantially around the time of diagnosis (relative hazard rate [RR] around 21) but remained elevated for a further 4 years (RRs around 1.5-2.0). The mean percentage of time spent within the therapeutic range for international normalized ratio (INR) was 57.0%. The lowest rate of VTE recurrence occurred in patients with ≥70% time spent within therapeutic range (RR of 0.50, 95% CI 0.39-0.63 compared to <30%). Conclusions: Higher time spent within therapeutic INR range was associated with lower risks of VTE recurrence and death due to VTE.
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Gallagher et al. (2012) conducted a cohort in Venous thromboembolism (n=184,359). ≥70% time spent within therapeutic INR range vs. <30% time spent within therapeutic INR range was evaluated on VTE recurrence (RR 0.50, 95% CI 0.39-0.63).
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