International normalized ratio stabilization in newly initiated warfarin patients with nonvalvular atrial fibrillation.
Curr Med Res Opin. 2014 Aug 29;:1-21
Authors: Nelson WW, Desai S, Damaraju CV, Lu L, Fields LE, Wildgoose P, Schein JR
Abstract Background-Warfarin is effective for stroke prevention in patients with atrial fibrillation (AF), but international normalized ratio (INR) levels fluctuate and frequent monitoring is necessary. Methods-This study used data from a large anticoagulation management service database to analyze the relationship between INR stabilization and warfarin utilization for >1 year in patients with nonvalvular AF (NVAF). Anticoagulation records from a large United States (US) electronic database collected from 2006 to 2010 were analyzed. Results-Patients with NVAF and ≥3 INR values in the dataset were identified (n=15,276). INR stabilization was defined as the first three consecutive INR values between 2.0 and 3.0 after warfarin initiation. One quarter of patients (n=3809) failed to reach INR stabilization. After initial stabilization, 30% of subsequent INR values were out of range. The mean (± standard deviation [SD]) follow-up time from stabilization to the end of study for these patients was 494.2±418.1 days. Age ≥75 years (odds ratio [OR]=1.17, 95% confidence interval [CI]=1.08-1.27), hypertension (OR=1.19, 95% CI=1.10-1.29), or prior stroke (OR=1.29, 95% CI=1.04-1.61) were positively associated with achieving stabilization; heart failure was negatively associated with stabilization (OR=0.78, 95% CI=0.70-0.87). Male gender (p<0.0001) and hypertension were associated with earlier stabilization (p=0.0013); heart failure was associated with later stabilization (p=0.0098). Patients who achieved INR stabilization within 1 year were 10 times more likely to remain on warfarin than patients who did not achieve it. Limitations-Observational data may contain incomplete records. Data on adherence, concurrent medications, vitamin K intake, genotype, reasons for discontinuation of monitoring, and patient outcomes were not available in the dataset. The study findings were generalizable only to patients with AF who were managed by anticoagulation clinics. Conclusion-Given the importance of stroke prevention among patients with AF, the potential for unpredictable INR patterns should be carefully considered during clinical decision-making.
PMID: 25170587 [PubMed - as supplied by publisher]