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Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine

Background and objectives: Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study was to evaluate the relationship between time in therapeutic range (TTR) an...

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Autores principales: Martín-Sánchez, Rubén Ángel, Lorenzo-Villalba, Noel, Calvo-Elías, Alberto Elpidio, Dubón-Peralta, Ester Emilia, Chocrón-Benbunan, Cynthia Elisa, Cano-de Luque, Carmen María, López-García, Lidia, Rivas-Molinero, María, Outón-González, Cristina, Marco-Martínez, Javier, Calvo-Manuel, Elpidio, Andres, Emmanuel, Méndez-Bailón, Manuel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069311/
https://www.ncbi.nlm.nih.gov/pubmed/33918627
http://dx.doi.org/10.3390/medicina57040365
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author Martín-Sánchez, Rubén Ángel
Lorenzo-Villalba, Noel
Calvo-Elías, Alberto Elpidio
Dubón-Peralta, Ester Emilia
Chocrón-Benbunan, Cynthia Elisa
Cano-de Luque, Carmen María
López-García, Lidia
Rivas-Molinero, María
Outón-González, Cristina
Marco-Martínez, Javier
Calvo-Manuel, Elpidio
Andres, Emmanuel
Méndez-Bailón, Manuel
author_facet Martín-Sánchez, Rubén Ángel
Lorenzo-Villalba, Noel
Calvo-Elías, Alberto Elpidio
Dubón-Peralta, Ester Emilia
Chocrón-Benbunan, Cynthia Elisa
Cano-de Luque, Carmen María
López-García, Lidia
Rivas-Molinero, María
Outón-González, Cristina
Marco-Martínez, Javier
Calvo-Manuel, Elpidio
Andres, Emmanuel
Méndez-Bailón, Manuel
author_sort Martín-Sánchez, Rubén Ángel
collection PubMed
description Background and objectives: Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study was to evaluate the relationship between time in therapeutic range (TTR) and the risk of early readmission. Materials and Methods: A retrospective descriptive study was carried out on hospitalized patients with a diagnosis of HF between 2014 and 2018 who had adverse effects due to oral anticoagulation with acenocoumarol (underdosing, overdosing, or hemorrhage). Clinical, analytical, therapeutic, and prognostic variables were collected. TTR is defined as the duration of time in which the patient’s International Normalized Ratio (INR) values were within a desired range. Early readmission was defined as readmission within 30 days after hospital discharge. Patients were divided into two groups depending on whether or not they had a TTR less than 60% (TTR < 60%) over the 6 months prior to the adverse event. Results: In the cohort of 304 patients, the mean age was 82 years, 59.9% of the patients were female, and 54.6% had a TTR < 60%. Patients with TTR < 60% had a higher HAS-BLED score (4.04 vs. 2.59; p < 0.001) and INR (6 vs. 5.31; p < 0.05) but lower hemoglobin (11.67 vs. 12.22 g/dL; p < 0.05). TTR < 60% was associated with early readmission after multivariate analysis (OR: 2.05 (CI 95%: 1.16–3.61)). They also had a higher percentage of hemorrhagic events and in-hospital mortality but without reaching statistical significance. Conclusions: Patients with HF and adverse events due to acenocoumarol often have poor INR control, which is independently associated with a higher risk of early readmission.
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spelling pubmed-80693112021-04-26 Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine Martín-Sánchez, Rubén Ángel Lorenzo-Villalba, Noel Calvo-Elías, Alberto Elpidio Dubón-Peralta, Ester Emilia Chocrón-Benbunan, Cynthia Elisa Cano-de Luque, Carmen María López-García, Lidia Rivas-Molinero, María Outón-González, Cristina Marco-Martínez, Javier Calvo-Manuel, Elpidio Andres, Emmanuel Méndez-Bailón, Manuel Medicina (Kaunas) Article Background and objectives: Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study was to evaluate the relationship between time in therapeutic range (TTR) and the risk of early readmission. Materials and Methods: A retrospective descriptive study was carried out on hospitalized patients with a diagnosis of HF between 2014 and 2018 who had adverse effects due to oral anticoagulation with acenocoumarol (underdosing, overdosing, or hemorrhage). Clinical, analytical, therapeutic, and prognostic variables were collected. TTR is defined as the duration of time in which the patient’s International Normalized Ratio (INR) values were within a desired range. Early readmission was defined as readmission within 30 days after hospital discharge. Patients were divided into two groups depending on whether or not they had a TTR less than 60% (TTR < 60%) over the 6 months prior to the adverse event. Results: In the cohort of 304 patients, the mean age was 82 years, 59.9% of the patients were female, and 54.6% had a TTR < 60%. Patients with TTR < 60% had a higher HAS-BLED score (4.04 vs. 2.59; p < 0.001) and INR (6 vs. 5.31; p < 0.05) but lower hemoglobin (11.67 vs. 12.22 g/dL; p < 0.05). TTR < 60% was associated with early readmission after multivariate analysis (OR: 2.05 (CI 95%: 1.16–3.61)). They also had a higher percentage of hemorrhagic events and in-hospital mortality but without reaching statistical significance. Conclusions: Patients with HF and adverse events due to acenocoumarol often have poor INR control, which is independently associated with a higher risk of early readmission. MDPI 2021-04-09 /pmc/articles/PMC8069311/ /pubmed/33918627 http://dx.doi.org/10.3390/medicina57040365 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Martín-Sánchez, Rubén Ángel
Lorenzo-Villalba, Noel
Calvo-Elías, Alberto Elpidio
Dubón-Peralta, Ester Emilia
Chocrón-Benbunan, Cynthia Elisa
Cano-de Luque, Carmen María
López-García, Lidia
Rivas-Molinero, María
Outón-González, Cristina
Marco-Martínez, Javier
Calvo-Manuel, Elpidio
Andres, Emmanuel
Méndez-Bailón, Manuel
Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine
title Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine
title_full Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine
title_fullStr Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine
title_full_unstemmed Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine
title_short Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine
title_sort clinical impact of the time in therapeutic range on early hospital readmission in patients with acute heart failure treated with oral anticoagulation in internal medicine
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069311/
https://www.ncbi.nlm.nih.gov/pubmed/33918627
http://dx.doi.org/10.3390/medicina57040365
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