Quality of anticoagulation with warfarin in Korean patients with atrial fibrillation and prior stroke: A multicenter retrospective observational study

Keun Sik Hong, Yang Ki Kim, Hee Joon Bae, Hyo Suk Nam, Sun U. Kwon, Oh Young Bang, Jae Kwan Cha, Byung Woo Yoon, Joung Ho Rha, Byung Chul Lee, Jong Moo Park, Man Seok Park, Jun Lee, Jay Chol Choi, Dong Eog Kim, Kyung Bok Lee, Tai Hwan Park, Ji Sung Lee, Seong Eun Kim, Juneyoung Lee

Research output: Contribution to journalArticle

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Abstract

Background and Purpose The quality of anticoagulation is critical for ensuring the benefit of warfarin, but this has been less well studied in Korean ischemic stroke patients with atrial fibrillation (AF). Methods This study retrospectively analyzed the data of patients who had an AF-related ischemic stroke and were treated with long-term warfarin therapy in 16 Korean centers. The quality of warfarin therapy was primarily assessed by the time in therapeutic range [TTR; international normalized ratio (INR), 2.0–3.0] and additionally by the proportion of INR values within the therapeutic range. Results The long-term warfarin-treated cohort comprised 1,230 patients. They were aged 70.1±9.7 years (mean±SD), 42.5% were female, and their CHA2DS2-VASc score was 4.75±1.41. The TTR analysis included 33,941 INR measurements for 27,487 months: per patients, 27.6 (SD, 22.4) INR measurements for 22.4 (SD, 12.9) months. The mean TTR of individual patients was 49.1% (95% confidence interval, 47.9–50.3%), and the TTR quartiles were <34.5, 34.5–49.1, 49.1– 64.5%, and >64.5%. None of the 16 centers achieved a mean TTR of >60%. Of all INR measurements, 44.6% were within the therapeutic range, 41.7% were <2.0, and 13.7% were >3.0. Conclusions In Korean ischemic stroke patients who had AF, the quality of warfarin therapy was low and might be inadequate to effectively prevent recurrent stroke or systemic embolism.

Original languageEnglish
Pages (from-to)273-280
Number of pages8
JournalJournal of Clinical Neurology (Korea)
Volume13
Issue number3
DOIs
Publication statusPublished - 2017 Jan 1

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Warfarin
International Normalized Ratio
Atrial Fibrillation
Observational Studies
Retrospective Studies
Stroke
Therapeutics
Embolism
Confidence Intervals

Keywords

  • Atrial fibrillation
  • Quality
  • Seconadry stroke prevention
  • Time in therapeutic range
  • Warfarin

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Quality of anticoagulation with warfarin in Korean patients with atrial fibrillation and prior stroke : A multicenter retrospective observational study. / Hong, Keun Sik; Kim, Yang Ki; Bae, Hee Joon; Nam, Hyo Suk; Kwon, Sun U.; Bang, Oh Young; Cha, Jae Kwan; Yoon, Byung Woo; Rha, Joung Ho; Lee, Byung Chul; Park, Jong Moo; Park, Man Seok; Lee, Jun; Choi, Jay Chol; Kim, Dong Eog; Lee, Kyung Bok; Park, Tai Hwan; Lee, Ji Sung; Kim, Seong Eun; Lee, Juneyoung.

In: Journal of Clinical Neurology (Korea), Vol. 13, No. 3, 01.01.2017, p. 273-280.

Research output: Contribution to journalArticle

Hong, KS, Kim, YK, Bae, HJ, Nam, HS, Kwon, SU, Bang, OY, Cha, JK, Yoon, BW, Rha, JH, Lee, BC, Park, JM, Park, MS, Lee, J, Choi, JC, Kim, DE, Lee, KB, Park, TH, Lee, JS, Kim, SE & Lee, J 2017, 'Quality of anticoagulation with warfarin in Korean patients with atrial fibrillation and prior stroke: A multicenter retrospective observational study', Journal of Clinical Neurology (Korea), vol. 13, no. 3, pp. 273-280. https://doi.org/10.3988/jcn.2017.13.3.273
Hong, Keun Sik ; Kim, Yang Ki ; Bae, Hee Joon ; Nam, Hyo Suk ; Kwon, Sun U. ; Bang, Oh Young ; Cha, Jae Kwan ; Yoon, Byung Woo ; Rha, Joung Ho ; Lee, Byung Chul ; Park, Jong Moo ; Park, Man Seok ; Lee, Jun ; Choi, Jay Chol ; Kim, Dong Eog ; Lee, Kyung Bok ; Park, Tai Hwan ; Lee, Ji Sung ; Kim, Seong Eun ; Lee, Juneyoung. / Quality of anticoagulation with warfarin in Korean patients with atrial fibrillation and prior stroke : A multicenter retrospective observational study. In: Journal of Clinical Neurology (Korea). 2017 ; Vol. 13, No. 3. pp. 273-280.
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abstract = "Background and Purpose The quality of anticoagulation is critical for ensuring the benefit of warfarin, but this has been less well studied in Korean ischemic stroke patients with atrial fibrillation (AF). Methods This study retrospectively analyzed the data of patients who had an AF-related ischemic stroke and were treated with long-term warfarin therapy in 16 Korean centers. The quality of warfarin therapy was primarily assessed by the time in therapeutic range [TTR; international normalized ratio (INR), 2.0–3.0] and additionally by the proportion of INR values within the therapeutic range. Results The long-term warfarin-treated cohort comprised 1,230 patients. They were aged 70.1±9.7 years (mean±SD), 42.5{\%} were female, and their CHA2DS2-VASc score was 4.75±1.41. The TTR analysis included 33,941 INR measurements for 27,487 months: per patients, 27.6 (SD, 22.4) INR measurements for 22.4 (SD, 12.9) months. The mean TTR of individual patients was 49.1{\%} (95{\%} confidence interval, 47.9–50.3{\%}), and the TTR quartiles were <34.5, 34.5–49.1, 49.1– 64.5{\%}, and >64.5{\%}. None of the 16 centers achieved a mean TTR of >60{\%}. Of all INR measurements, 44.6{\%} were within the therapeutic range, 41.7{\%} were <2.0, and 13.7{\%} were >3.0. Conclusions In Korean ischemic stroke patients who had AF, the quality of warfarin therapy was low and might be inadequate to effectively prevent recurrent stroke or systemic embolism.",
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T1 - Quality of anticoagulation with warfarin in Korean patients with atrial fibrillation and prior stroke

T2 - A multicenter retrospective observational study

AU - Hong, Keun Sik

AU - Kim, Yang Ki

AU - Bae, Hee Joon

AU - Nam, Hyo Suk

AU - Kwon, Sun U.

AU - Bang, Oh Young

AU - Cha, Jae Kwan

AU - Yoon, Byung Woo

AU - Rha, Joung Ho

AU - Lee, Byung Chul

AU - Park, Jong Moo

AU - Park, Man Seok

AU - Lee, Jun

AU - Choi, Jay Chol

AU - Kim, Dong Eog

AU - Lee, Kyung Bok

AU - Park, Tai Hwan

AU - Lee, Ji Sung

AU - Kim, Seong Eun

AU - Lee, Juneyoung

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background and Purpose The quality of anticoagulation is critical for ensuring the benefit of warfarin, but this has been less well studied in Korean ischemic stroke patients with atrial fibrillation (AF). Methods This study retrospectively analyzed the data of patients who had an AF-related ischemic stroke and were treated with long-term warfarin therapy in 16 Korean centers. The quality of warfarin therapy was primarily assessed by the time in therapeutic range [TTR; international normalized ratio (INR), 2.0–3.0] and additionally by the proportion of INR values within the therapeutic range. Results The long-term warfarin-treated cohort comprised 1,230 patients. They were aged 70.1±9.7 years (mean±SD), 42.5% were female, and their CHA2DS2-VASc score was 4.75±1.41. The TTR analysis included 33,941 INR measurements for 27,487 months: per patients, 27.6 (SD, 22.4) INR measurements for 22.4 (SD, 12.9) months. The mean TTR of individual patients was 49.1% (95% confidence interval, 47.9–50.3%), and the TTR quartiles were <34.5, 34.5–49.1, 49.1– 64.5%, and >64.5%. None of the 16 centers achieved a mean TTR of >60%. Of all INR measurements, 44.6% were within the therapeutic range, 41.7% were <2.0, and 13.7% were >3.0. Conclusions In Korean ischemic stroke patients who had AF, the quality of warfarin therapy was low and might be inadequate to effectively prevent recurrent stroke or systemic embolism.

AB - Background and Purpose The quality of anticoagulation is critical for ensuring the benefit of warfarin, but this has been less well studied in Korean ischemic stroke patients with atrial fibrillation (AF). Methods This study retrospectively analyzed the data of patients who had an AF-related ischemic stroke and were treated with long-term warfarin therapy in 16 Korean centers. The quality of warfarin therapy was primarily assessed by the time in therapeutic range [TTR; international normalized ratio (INR), 2.0–3.0] and additionally by the proportion of INR values within the therapeutic range. Results The long-term warfarin-treated cohort comprised 1,230 patients. They were aged 70.1±9.7 years (mean±SD), 42.5% were female, and their CHA2DS2-VASc score was 4.75±1.41. The TTR analysis included 33,941 INR measurements for 27,487 months: per patients, 27.6 (SD, 22.4) INR measurements for 22.4 (SD, 12.9) months. The mean TTR of individual patients was 49.1% (95% confidence interval, 47.9–50.3%), and the TTR quartiles were <34.5, 34.5–49.1, 49.1– 64.5%, and >64.5%. None of the 16 centers achieved a mean TTR of >60%. Of all INR measurements, 44.6% were within the therapeutic range, 41.7% were <2.0, and 13.7% were >3.0. Conclusions In Korean ischemic stroke patients who had AF, the quality of warfarin therapy was low and might be inadequate to effectively prevent recurrent stroke or systemic embolism.

KW - Atrial fibrillation

KW - Quality

KW - Seconadry stroke prevention

KW - Time in therapeutic range

KW - Warfarin

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