Key result
Poorly controlled anticoagulation shows no significant increase in stroke risk versus well-controlled treatment.
Why the study?
Many patients with atrial fibrillation receiving vitamin K antagonist prophylaxis fail to achieve target coagulation status, increasing risk of stroke and bleeding.
Does well-controlled vitamin K antagonist treatment (TTR >70%) reduce stroke and bleeding events compared to poorly controlled treatment in adult patients with nonvalvular atrial fibrillation?
Population
6250 adult patients with nonvalvular atrial fibrillation prescribed vitamin K antagonists in France, Germany, Italy, and the United Kingdom
Comparison
Well-controlled treatment (time in therapeutic range >70%) vs poorly controlled treatment (time in therapeutic range ≤70%)
Design
Observational cohort study using European electronic primary care database
Authors
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Non-significant stroke risk increase with poor TTR control should not change practice; leaves open whether optimizing VKA therapy reduces events in nonvalvular AF.
Observational (n=6,250)
Yes
Does well-controlled vitamin K antagonist treatment (TTR >70%) reduce stroke and bleeding events compared to poorly controlled treatment in adult patients with nonvalvular atrial fibrillation?
Odds Ratio: 1.38 (95% CI 0.93–2.06)
Absolute Event Rate: 1% vs 0.5%
p-value: p=0.110
A large proportion of atrial fibrillation patients on vitamin K antagonists in European primary care have poorly controlled anticoagulation, exposing them to unnecessary risks, though differences in stroke and bleeding events did not reach statistical significance after adjustment.
Cotté et al. (2014) conducted an observational in Nonvalvular atrial fibrillation (n=6,250). Poorly controlled anticoagulation (time in therapeutic range ≤70%) vs. Well-controlled anticoagulation (time in therapeutic range >70%) was evaluated on Stroke (OR 1.38, 95% CI 0.93-2.06, p=0.110). Poorly controlled anticoagulation (TTR ≤70%) was associated with a non-significant increase in stroke risk compared to well-controlled treatment (OR 1.38; 95% CI 0.93-2.06; P=0.110).
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