Naja Emborg Vinding1, Anders Nissen Bonde2, Rasmus Rørth1, Morten Lamberts1,2, Jonas Bjerring Olesen2, Gunnar Hilmar Gislason2,3,4, Christian Torp-Pedersen5,6, Lars Køber1, Emil Loldrup Fosbøl1. 1. Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 3, København Ø, Denmark. 2. Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Kildegaardsvej 28, Hellerup, Denmark. 3. The Danish Heart Foundation, Vognmagergade 7, Copenhagen, Denmark. 4. The National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, Copenhagen, Denmark. 5. Institute of Health, Science and Technology, Aalborg University, Niels Jernes Vej 12, Aalborg Ø, Denmark. 6. Aalborg University Hospital, Unit of Epidemiology and Biostatistics, Aalborg, Denmark.
Abstract
AIMS: Patients with non-valvular atrial fibrillation (NVAF) receiving vitamin K antagonists (VKAs) with time in therapeutic international normalized ratio (INR) range (TTR) <70%, despite good adherence, are by guidelines recommended to switch to non-VKA oral anticoagulants (NOACs). The aim was to assess if patients are switched from VKA to NOAC when TTR is <70% in a real-world setting. METHODS AND RESULTS: Non-valvular atrial fibrillation patients receiving VKA (1 January 2010 to 31 December 2012) were identified in nationwide registries. Time in therapeutic range was calculated by the Rosendaal method by a minimum of three INR values. Time in therapeutic range of patients continuing VKA (non-switchers) were compared with patients switched from VKA to dabigatran or rivaroxaban (switchers), the only NOACs available at that time. Factors associated with switching were analysed in a multivariable logistic regression model. 7276 patients with NVAF receiving VKA were included; of these, 6437 (88.5%) patients continued VKA [57.9% male, median age 76.7 years (Q1-Q3 68.9-83.5)] and 839 (11.5%) switched to NOAC [54.0% male, median age 76.5 years (Q1-Q3 68.4-83.6)]. No significant differences in CHA2DS2-VASc and HAS-BLED scores were seen between the groups. The mean TTR for non-switchers was 64.0 [standard deviation (SD) 27.8] and 52.9 (SD 28.1) for switchers. Among non-switchers, 51% had a TTR <70% vs. 69% among switchers. 85% of patients with TTR <70%, were not switched contrary to recommendations. Time in therapeutic range <70% was associated with the switch [odds ratio 2.28, 95% confidence interval (1.92-2.72)]. CONCLUSION: A TTR below 70% was associated with switching from VKA to NOAC, yet by guidelines, most patients were still not switched. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Patients with non-valvular atrial fibrillation (NVAF) receiving vitamin K antagonists (VKAs) with time in therapeutic international normalized ratio (INR) range (TTR) <70%, despite good adherence, are by guidelines recommended to switch to non-VKA oral anticoagulants (NOACs). The aim was to assess if patients are switched from VKA to NOAC when TTR is <70% in a real-world setting. METHODS AND RESULTS:Non-valvular atrial fibrillationpatients receiving VKA (1 January 2010 to 31 December 2012) were identified in nationwide registries. Time in therapeutic range was calculated by the Rosendaal method by a minimum of three INR values. Time in therapeutic range of patients continuing VKA (non-switchers) were compared with patients switched from VKA to dabigatran or rivaroxaban (switchers), the only NOACs available at that time. Factors associated with switching were analysed in a multivariable logistic regression model. 7276 patients with NVAF receiving VKA were included; of these, 6437 (88.5%) patients continued VKA [57.9% male, median age 76.7 years (Q1-Q3 68.9-83.5)] and 839 (11.5%) switched to NOAC [54.0% male, median age 76.5 years (Q1-Q3 68.4-83.6)]. No significant differences in CHA2DS2-VASc and HAS-BLED scores were seen between the groups. The mean TTR for non-switchers was 64.0 [standard deviation (SD) 27.8] and 52.9 (SD 28.1) for switchers. Among non-switchers, 51% had a TTR <70% vs. 69% among switchers. 85% of patients with TTR <70%, were not switched contrary to recommendations. Time in therapeutic range <70% was associated with the switch [odds ratio 2.28, 95% confidence interval (1.92-2.72)]. CONCLUSION: A TTR below 70% was associated with switching from VKA to NOAC, yet by guidelines, most patients were still not switched. Published on behalf of the European Society of Cardiology. All rights reserved.
Keywords:
Guideline adherence; International normalized ratio ; Non-vitamin K antagonist oral anticoagulants ; Switching therapies ; Time in therapeutic range ; Vitamin K antagonist
Authors: Naja E Vinding; Søren L Kristensen; Rasmus Rørth; Jawad H Butt; Lauge Østergaard; Jonas B Olesen; Christian Torp-Pedersen; Gunnar H Gislason; Lars Køber; Christina Kruuse; Søren P Johnsen; Emil L Fosbøl Journal: J Am Heart Assoc Date: 2022-02-12 Impact factor: 6.106