Seil Oh1, Shinya Goto2, Gabriele Accetta3, Pantep Angchaisuksiri4, A John Camm5, Frank Cools6, Sylvia Haas7, Gloria Kayani3, Yukihiro Koretsune8, Toon Wei Lim9, Frank Misselwitz10, Martin van Eickels10, Ajay K Kakkar11. 1. Seoul National University Hospital, Seoul, South Korea. Electronic address: seil@snu.ac.kr. 2. Tokai University, Kanagawa, Japan. 3. Thrombosis Research Institute, London, UK. 4. Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. 5. St George's University of London, London, UK. 6. AZ Klina, Brasschaat, Belgium. 7. Formerly Technical University of Munich, Munich, Germany. 8. Institute for Clinical Research, National Hospital Organization, Osaka National Hospital, Osaka, Japan. 9. National University Hospital, Singapore. 10. Bayer Pharma AG, Berlin, Germany. 11. Thrombosis Research Institute, London, UK; University College London, London, UK.
Abstract
OBJECTIVE: To compare the distribution of international normalized ratios (INRs) in patients receiving vitamin K antagonist (VKA) for newly diagnosed atrial fibrillation in Eastern and Southeastern Asia and in other regions of the world (ORW) represented in the ongoing, global observational study GARFIELD-AF. METHODS AND RESULTS: 3621 and 13,541 patients were recruited prospectively in 2010-2013 from Asia and ORW, respectively. At baseline, excluding patients with unknown antithrombotic treatment, 1356 (37.8%) in Asia and 7081 (53.3%) in ORW received VKA (±antiplatelets). INR readings during 1-year follow-up were analyzed for VKA-treated patients with ≥3 measurements (878 [64.7%] patients in Asia, 4452 [62.9%] in ORW). VKA-treated patients in Asia were younger than those in ORW (mean 67.1 vs 71.3years), with a lower CHA2DS2-VASc score (3.0 vs 3.5), but a similar HAS-BLED score (1.3 vs 1.4). Mean INR was lower in Asia than in ORW (2.0 vs 2.4). The proportion of time in the therapeutic range, defined using the multinational target of 2.0-3.0, was substantially lower in Asia (31.1% vs 54.1%). In Asia and ORW, 59.3% and 28.2% of INRs were <2, and 9.6% and 17.7% were >3, respectively. The same trend was found in different age groups (<65, 65-74, ≥75years). CONCLUSION: GARFIELD-AF data demonstrate a difference in the distribution of INRs in patients from Asia versus other regions under current real-world practice. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.
OBJECTIVE: To compare the distribution of international normalized ratios (INRs) in patients receiving vitamin K antagonist (VKA) for newly diagnosed atrial fibrillation in Eastern and Southeastern Asia and in other regions of the world (ORW) represented in the ongoing, global observational study GARFIELD-AF. METHODS AND RESULTS: 3621 and 13,541 patients were recruited prospectively in 2010-2013 from Asia and ORW, respectively. At baseline, excluding patients with unknown antithrombotic treatment, 1356 (37.8%) in Asia and 7081 (53.3%) in ORW received VKA (±antiplatelets). INR readings during 1-year follow-up were analyzed for VKA-treated patients with ≥3 measurements (878 [64.7%] patients in Asia, 4452 [62.9%] in ORW). VKA-treated patients in Asia were younger than those in ORW (mean 67.1 vs 71.3years), with a lower CHA2DS2-VASc score (3.0 vs 3.5), but a similar HAS-BLED score (1.3 vs 1.4). Mean INR was lower in Asia than in ORW (2.0 vs 2.4). The proportion of time in the therapeutic range, defined using the multinational target of 2.0-3.0, was substantially lower in Asia (31.1% vs 54.1%). In Asia and ORW, 59.3% and 28.2% of INRs were <2, and 9.6% and 17.7% were >3, respectively. The same trend was found in different age groups (<65, 65-74, ≥75years). CONCLUSION: GARFIELD-AF data demonstrate a difference in the distribution of INRs in patients from Asia versus other regions under current real-world practice. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.
Authors: Sylvia Haas; Hugo Ten Cate; Gabriele Accetta; Pantep Angchaisuksiri; Jean-Pierre Bassand; A John Camm; Ramon Corbalan; Harald Darius; David A Fitzmaurice; Samuel Z Goldhaber; Shinya Goto; Barry Jacobson; Gloria Kayani; Lorenzo G Mantovani; Frank Misselwitz; Karen Pieper; Sebastian M Schellong; Janina Stepinska; Alexander G G Turpie; Martin van Eickels; Ajay K Kakkar Journal: PLoS One Date: 2016-10-28 Impact factor: 3.240