ArticleInternational journal of clinical pharmacy2015
Out-of-range INR values and outcomes among new warfarin patients with non-valvular atrial fibrillation.
Article in International journal of clinical pharmacy, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Meta-Analysis Comparing Oral Anticoagulant Monotherapy Versus Dual Antithrombotic Therapy in Patients With Atrial Fibrillation and Stable Coronary Artery Disease.Clinical cardiology · 2024Pooled it
- Associations between model-predicted rivaroxaban exposure and patient characteristics and efficacy and safety outcomes in patients with non-valvular atrial fibrillation.Journal of thrombosis and thrombolysis · 2020Trial
- Effect of internet plus nursing mode telehealth intervention on warfarin management in atrial fibrillation patients.Frontiers in cardiovascular medicine · 2026Article
- Comparing the post-operative complications following surgery for hip fracture of patients who were on warfarin versus patients who were on novel oral anticoagulants: a meta-analysis.Perioperative medicine (London, England) · 2025Article
- Maxillofacial haemorrhagic symptoms in emergency department patients: impact of antithrombotics.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Article
- Atrial Fibrillation and Reperfusion Therapy in Acute Ischaemic Stroke Patients: Prevalence and Outcomes-A Comprehensive Systematic Review and Meta-Analysis.Neurology international · 2023Article
- The association between prothrombin time-international normalized ratio and long-term mortality in patients with coronary artery disease: a large cohort retrospective study with 44,662 patients.BMC cardiovascular disorders · 2022Article
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- The effect of simvastatin on warfarin anticoagulation: a Swedish register-based nationwide cohort study.European journal of clinical pharmacology · 2019Article
- Feasibility and safety of percutaneous epicardial access for mapping and ablation for ventricular arrhythmias in patients on oral anticoagulants.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2019Article
- Characteristics of patients with thromboembolic disorders on warfarin therapy in resource limited settings.BMC health services research · 2018Article
- Pharmacogenomics Guided-Personalization of Warfarin and Tamoxifen.Journal of personalized medicine · 2017Review
- A Review of the Relationship of Atrial Fibrillation and Acute Coronary Syndrome.Current emergency and hospital medicine reports · 2016Article
- Vitamin K antagonist use: evidence of the difficulty of achieving and maintaining target INR range and subsequent consequences.Thrombosis journal · 2016Review
- Observational
- Reducing The Risk Of Stroke In Patients With Nonvalvular Atrial Fibrillation With Direct Oral Anticoagulants. Is One Of These Not Like The Others?Journal of atrial fibrillationReview
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAlthough efficacious in stroke prevention in non-valvular atrial fibrillation, many warfarin patients are sub-optimally managed.
objectiveTo evaluate the association of international normalized ratio control and clinical outcomes among new warfarin patients with non-valvular atrial fibrillation.
settingAdult non-valvular atrial fibrillation patients (≥18 years) initiating warfarin treatment were selected from the US Veterans Health Administration dataset between 10/2007 and 9/2012.
methodValid international normalized ratio values were examined from the warfarin initiation date through the earlier of the first clinical outcome, end of warfarin exposure or death. Each patient contributed multiple in-range and out-of-range time periods.
main outcome measureThe relative risk ratios of clinical outcomes associated with international normalized ratio control were estimated.
results34,346 patients were included for analysis. During the warfarin exposure period, the incidence of events per 100 person-years was highest when patients had international normalized ratio <2:13.66 for acute coronary syndrome; 10.30 for ischemic stroke; 2.93 for transient ischemic attack; 1.81 for systemic embolism; and 4.55 for major bleeding. Poisson regression confirmed that during periods with international normalized ratio <2, patients were at increased risk of developing acute coronary syndrome (relative risk ratio: 7.9; 95 % confidence interval 6.9-9.1), ischemic stroke (relative risk ratio: 7.6; 95 % confidence interval 6.5-8.9), transient ischemic attack (relative risk ratio: 8.2; 95 % confidence interval 6.1-11.2), systemic embolism (relative risk ratio: 6.3; 95 % confidence interval 4.4-8.9) and major bleeding (relative risk ratio: 2.6; 95 % confidence interval 2.2-3.0). During time periods with international normalized ratio >3, patients had significantly increased risk of major bleeding (relative risk ratio: 1.5; 95 % confidence interval 1.2-2.0).
conclusionIn a Veterans Health Administration non-valvular atrial fibrillation population, exposure to out-of-range international normalized ratio values was associated with significantly increased risk of adverse clinical outcomes.
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