Subtherapeutic Anticoagulation Control under Treatment with Vitamin K-Antagonists-Data from a Specialized Coagulation Service
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Subtherapeutic Anticoagulation Control under Treatment with Vitamin K-Antagonists-Data from a Specialized Coagulation Service. / Prochaska, Jürgen H; Hausner, Christoph; Nagler, Markus; Göbel, Sebastian; Eggebrecht, Lisa; Panova-Noeva, Marina; Arnold, Natalie; Lauterbach, Michael; Bickel, Christoph; Michal, Matthias; Hardt, Roland; Espinola-Klein, Christine; Lackner, Karl J; Münzel, Thomas; Wild, Philipp S.
In: THROMB HAEMOSTASIS, Vol. 119, No. 8, 08.2019, p. 1347-1357.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research
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TY - JOUR
T1 - Subtherapeutic Anticoagulation Control under Treatment with Vitamin K-Antagonists-Data from a Specialized Coagulation Service
AU - Prochaska, Jürgen H
AU - Hausner, Christoph
AU - Nagler, Markus
AU - Göbel, Sebastian
AU - Eggebrecht, Lisa
AU - Panova-Noeva, Marina
AU - Arnold, Natalie
AU - Lauterbach, Michael
AU - Bickel, Christoph
AU - Michal, Matthias
AU - Hardt, Roland
AU - Espinola-Klein, Christine
AU - Lackner, Karl J
AU - Münzel, Thomas
AU - Wild, Philipp S
N1 - Georg Thieme Verlag KG Stuttgart · New York.
PY - 2019/8
Y1 - 2019/8
N2 - In contrast to overanticoagulation, evidence on risk factors and outcome of subtherapeutic oral anticoagulation (OAC) with vitamin K-antagonists (VKAs) under optimum care is limited. We investigated the clinical phenotype, anticoagulation control, and clinical outcome of 760 VKA patients who received OAC therapy by a specialized coagulation service in the thrombEVAL study (NCT01809015). During 281,934 treatment days, 278 patients experience ≥ 1 episode of subtherapeutic anticoagulation control and had lower quality of OAC therapy compared to 482 patients without subtherapeutic international normalized ratio: 67.6%, interquartile range (IQR) 54.9%/76.8% versus 81.0%, IQR 68.5%/90.4%; p < 0.001. In Cox regression analysis with adjustment for age, sex, cardiovascular risk factors, comorbidities, and treatment characteristics, female sex (hazard ratio [HR], 1.4, 95% confidence interval [CI], 1.0/1.9; p = 0.03), diabetes (HR, 1.4, 95% CI, 1.0/2.0; p = 0.03), and living alone (HR, 1.5, 95% CI, 1.1/2.1; p = 0.009) were independent risk factors of subtherapeutic anticoagulation control, whereas atrial fibrillation (HR, 0.6, 95% CI, 0.4/0.9; p = 0.02) and self-management of OAC therapy (HR, 0.2, 95% CI, 0.1/0.6; p = 0.001) were protective. In addition, active smoking (HR, 1.7, 95% CI, 0.9/3.0; p = 0.086) and living in a nursing home (HR, 1.6, 95% CI, 0.8/3.2; p = 0.15) indicated an elevated risk at the borderline of statistical significance. For the prediction of recurrent subtherapeutic anticoagulation, living alone was the only independent risk factor (HR, 1.7, 95% CI, 1.1/2.5; p = 0.013). The present study suggests that women, diabetics, and patients living alone experience an increased risk of low-quality VKA therapy and might potentially benefit from treatment with direct-acting anticoagulants.
AB - In contrast to overanticoagulation, evidence on risk factors and outcome of subtherapeutic oral anticoagulation (OAC) with vitamin K-antagonists (VKAs) under optimum care is limited. We investigated the clinical phenotype, anticoagulation control, and clinical outcome of 760 VKA patients who received OAC therapy by a specialized coagulation service in the thrombEVAL study (NCT01809015). During 281,934 treatment days, 278 patients experience ≥ 1 episode of subtherapeutic anticoagulation control and had lower quality of OAC therapy compared to 482 patients without subtherapeutic international normalized ratio: 67.6%, interquartile range (IQR) 54.9%/76.8% versus 81.0%, IQR 68.5%/90.4%; p < 0.001. In Cox regression analysis with adjustment for age, sex, cardiovascular risk factors, comorbidities, and treatment characteristics, female sex (hazard ratio [HR], 1.4, 95% confidence interval [CI], 1.0/1.9; p = 0.03), diabetes (HR, 1.4, 95% CI, 1.0/2.0; p = 0.03), and living alone (HR, 1.5, 95% CI, 1.1/2.1; p = 0.009) were independent risk factors of subtherapeutic anticoagulation control, whereas atrial fibrillation (HR, 0.6, 95% CI, 0.4/0.9; p = 0.02) and self-management of OAC therapy (HR, 0.2, 95% CI, 0.1/0.6; p = 0.001) were protective. In addition, active smoking (HR, 1.7, 95% CI, 0.9/3.0; p = 0.086) and living in a nursing home (HR, 1.6, 95% CI, 0.8/3.2; p = 0.15) indicated an elevated risk at the borderline of statistical significance. For the prediction of recurrent subtherapeutic anticoagulation, living alone was the only independent risk factor (HR, 1.7, 95% CI, 1.1/2.5; p = 0.013). The present study suggests that women, diabetics, and patients living alone experience an increased risk of low-quality VKA therapy and might potentially benefit from treatment with direct-acting anticoagulants.
KW - Administration, Oral
KW - Aged
KW - Aged, 80 and over
KW - Anticoagulants/administration & dosage
KW - Atrial Fibrillation/drug therapy
KW - Blood Coagulation/drug effects
KW - Case-Control Studies
KW - Comorbidity
KW - Female
KW - Fibrinolytic Agents/therapeutic use
KW - Follow-Up Studies
KW - Hematology/organization & administration
KW - Humans
KW - International Normalized Ratio
KW - Male
KW - Middle Aged
KW - Phenotype
KW - Proportional Hazards Models
KW - Quality Control
KW - Recurrence
KW - Risk Factors
KW - Thrombolytic Therapy/methods
KW - Treatment Outcome
KW - Vitamin K/antagonists & inhibitors
U2 - 10.1055/s-0039-1692175
DO - 10.1055/s-0039-1692175
M3 - SCORING: Journal article
C2 - 31183847
VL - 119
SP - 1347
EP - 1357
JO - THROMB HAEMOSTASIS
JF - THROMB HAEMOSTASIS
SN - 0340-6245
IS - 8
ER -
