Key result
Vitamin K antagonist therapy with a time in therapeutic range ≥ 65% significantly reduced the risk of stroke compared to no antithrombotic treatment (HR 0.594) in patients with non-valvular atrial fibrillation.
Why the study?
Does vitamin K antagonist treatment reduce stroke risk in patients with non-valvular atrial fibrillation?
Cohort (n=6,138)
Does vitamin K antagonist treatment reduce stroke risk in patients with non-valvular atrial fibrillation?
In real-world practice, VKA therapy is underutilized and poorly controlled in NVAF patients, but when therapeutic targets (TTR ≥ 65%) are achieved, it significantly reduces stroke risk.
Answers are grounded in this paper and cite their sources.
Reinforces the clinical necessity of strict TTR control when using VKAs for NVAF;.
This retrospective observational study was based on databases of the Local Health Authority of Treviso, Italy. It evaluated the prevalence and the effectiveness of oral anticoagulation treatment (OAT) for the management of nonvalvular atrial fibrillation (NVAF) in everyday clinical practice. Out of 6,138 NVAF patients, only 3,024 received vitamin K antagonist (VKA). Potential barriers decreasing the probability of being treated with VKA were female sex, older age, antiplatelet treatment and history of bleeding. In addition, VKA-treatment was not in line with current ESC and AIAC guidelines, since the patients at high or low risk of stroke were under- or over-treated, resp. Among VKAtreated patients, 73 % of subjects were not at target with anticoagulation. OAT resulted to be effective in reducing stroke risk. However, stroke events were significantly influenced also by previous stroke or transient ischemic attack (hazard ratio, HR = 2.99, p < 0.001) and by previous bleeding events (HR = 1.60, p < 0.001).
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Deambrosis et al. (2017) conducted a cohort in Non-valvular atrial fibrillation (n=6,138). Vitamin K antagonist (VKA) vs. No VKA and no antiplatelet treatment was evaluated on First hospital admission with diagnosis of stroke (HR 0.594, 95% CI 0.435-0.810, p=0.001). Vitamin K antagonist therapy with a time in therapeutic range ≥ 65% significantly reduced the risk of stroke compared to no antithrombotic treatment (HR 0.594) in patients with non-valvular atrial fibrillation.
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