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An observational study of international normalized ratio control according to NICE criteria in patients with non-valvular atrial fibrillation: the SAIL Warfarin Out of Range Descriptors Study (SWORDS)
AIMS : In patients with non-valvular atrial fibrillation prescribed warfarin, the UK National Institute of Health and Care Excellence (NICE) defines poor anticoagulation as a time in therapeutic range (TTR) of <65%, any two international normalized ratios (INRs) within a 6-month period of ≤1.5 (‘...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811400/ https://www.ncbi.nlm.nih.gov/pubmed/31774502 http://dx.doi.org/10.1093/ehjcvp/pvz071 |
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author | Harris, Daniel E Thayer, Daniel Wang, Ting Brooks, Caroline Murley, Geoff Gravenor, Mike Hill, Nathan R Lister, Steven Halcox, Julian |
author_facet | Harris, Daniel E Thayer, Daniel Wang, Ting Brooks, Caroline Murley, Geoff Gravenor, Mike Hill, Nathan R Lister, Steven Halcox, Julian |
author_sort | Harris, Daniel E |
collection | PubMed |
description | AIMS : In patients with non-valvular atrial fibrillation prescribed warfarin, the UK National Institute of Health and Care Excellence (NICE) defines poor anticoagulation as a time in therapeutic range (TTR) of <65%, any two international normalized ratios (INRs) within a 6-month period of ≤1.5 (‘low’), two INRs ≥5 within 6 months, or any INR ≥8 (‘high’). Our objectives were to (i) quantify the number of patients with poor INR control and (ii) describe the demographic and clinical characteristics associated with poor INR control. METHOD AND RESULTS: Linked anonymized health record data for Wales, UK (2006–2017) was used to evaluate patients prescribed warfarin who had at least 6 months of INR data. 32 380 patients were included. In total, 13 913 (43.0%) patients had at least one of the NICE markers of poor INR control. Importantly, in the 24 123 (74.6%) of the cohort with an acceptable TTR (≥65%), 5676 (23.5%) had either low or high INR readings at some point in their history. In a multivariable regression female gender, age (≥75 years), excess alcohol, diabetes heart failure, ischaemic heart disease, and respiratory disease were independently associated with all markers of poor INR control. CONCLUSION : Acceptable INR control according to NICE standards is poor. Of those with an acceptable TTR (>65%), one-quarter still had unacceptably low or high INR levels according to NICE criteria. Thus, only using TTR to assess effectiveness with warfarin has the potential to miss a large number of patients with non-therapeutic INRs who are likely to be at increased risk. |
format | Online Article Text |
id | pubmed-7811400 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-78114002021-01-25 An observational study of international normalized ratio control according to NICE criteria in patients with non-valvular atrial fibrillation: the SAIL Warfarin Out of Range Descriptors Study (SWORDS) Harris, Daniel E Thayer, Daniel Wang, Ting Brooks, Caroline Murley, Geoff Gravenor, Mike Hill, Nathan R Lister, Steven Halcox, Julian Eur Heart J Cardiovasc Pharmacother Original Articles AIMS : In patients with non-valvular atrial fibrillation prescribed warfarin, the UK National Institute of Health and Care Excellence (NICE) defines poor anticoagulation as a time in therapeutic range (TTR) of <65%, any two international normalized ratios (INRs) within a 6-month period of ≤1.5 (‘low’), two INRs ≥5 within 6 months, or any INR ≥8 (‘high’). Our objectives were to (i) quantify the number of patients with poor INR control and (ii) describe the demographic and clinical characteristics associated with poor INR control. METHOD AND RESULTS: Linked anonymized health record data for Wales, UK (2006–2017) was used to evaluate patients prescribed warfarin who had at least 6 months of INR data. 32 380 patients were included. In total, 13 913 (43.0%) patients had at least one of the NICE markers of poor INR control. Importantly, in the 24 123 (74.6%) of the cohort with an acceptable TTR (≥65%), 5676 (23.5%) had either low or high INR readings at some point in their history. In a multivariable regression female gender, age (≥75 years), excess alcohol, diabetes heart failure, ischaemic heart disease, and respiratory disease were independently associated with all markers of poor INR control. CONCLUSION : Acceptable INR control according to NICE standards is poor. Of those with an acceptable TTR (>65%), one-quarter still had unacceptably low or high INR levels according to NICE criteria. Thus, only using TTR to assess effectiveness with warfarin has the potential to miss a large number of patients with non-therapeutic INRs who are likely to be at increased risk. Oxford University Press 2019-11-27 /pmc/articles/PMC7811400/ /pubmed/31774502 http://dx.doi.org/10.1093/ehjcvp/pvz071 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Harris, Daniel E Thayer, Daniel Wang, Ting Brooks, Caroline Murley, Geoff Gravenor, Mike Hill, Nathan R Lister, Steven Halcox, Julian An observational study of international normalized ratio control according to NICE criteria in patients with non-valvular atrial fibrillation: the SAIL Warfarin Out of Range Descriptors Study (SWORDS) |
title | An observational study of international normalized ratio control according to NICE criteria in patients with non-valvular atrial fibrillation: the SAIL Warfarin Out of Range Descriptors Study (SWORDS) |
title_full | An observational study of international normalized ratio control according to NICE criteria in patients with non-valvular atrial fibrillation: the SAIL Warfarin Out of Range Descriptors Study (SWORDS) |
title_fullStr | An observational study of international normalized ratio control according to NICE criteria in patients with non-valvular atrial fibrillation: the SAIL Warfarin Out of Range Descriptors Study (SWORDS) |
title_full_unstemmed | An observational study of international normalized ratio control according to NICE criteria in patients with non-valvular atrial fibrillation: the SAIL Warfarin Out of Range Descriptors Study (SWORDS) |
title_short | An observational study of international normalized ratio control according to NICE criteria in patients with non-valvular atrial fibrillation: the SAIL Warfarin Out of Range Descriptors Study (SWORDS) |
title_sort | observational study of international normalized ratio control according to nice criteria in patients with non-valvular atrial fibrillation: the sail warfarin out of range descriptors study (swords) |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811400/ https://www.ncbi.nlm.nih.gov/pubmed/31774502 http://dx.doi.org/10.1093/ehjcvp/pvz071 |
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