Anticoagulation Control and Prediction of Adverse Events in Patients With Atrial Fibrillation: A Systematic Review
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BACKGROUND: To date, there has been no systematic examination of the relationship between international normalized ratio (INR) control measurements and the prediction of adverse events in patients with atrial fibrillation on oral anticoagulation. METHODS AND RESULTS: We searched MEDLINE, EMBASE, and Cochrane through January 2008 for studies of atrial fibrillation patients receiving vitamin-K antagonists that reported INR control measures (percentage of time in therapeutic range [TTR] and percentage of INRs in range) and major hemorrhage and thromboembolic events. In total, 47 studies were included from 38 published articles. TTR ranged from 29% to 75%; percentage of INRs ranged from 34% to 84%. From studies reporting both measures, TTR significantly correlated with percentage of INRs in range (P<0.001). Randomized controlled trials had better INR control than retrospective studies (64.9% versus 56.4%; P=0.01). TTR negatively correlated with major hemorrhage (r=-0.59; P=0.002) and thromboembolic rates (r=-0.59; P=0.01). This effect was significant in retrospective studies (major hemorrhage, r=-0.78; P=0.006 and thromboembolic rate, r=-0.88; P=0.03) but not in randomized controlled trials (major hemorrhage, r=0.18; P=0.33 and thromboembolic rate, r=-0.61; P=0.07). For retrospective studies, a 6.9% improvement in the TTR significantly reduced major hemorrhage by 1 event per 100 patient-years of treatment (95% CI, 0.29 to 1.71 events). CONCLUSIONS: In atrial fibrillation patients receiving orally administered anticoagulation treatment, TTR and percentage of INRs in range effectively predict INR control. Data from retrospective studies support the use of TTR to accurately predict reductions in adverse events.
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Time in therapeutic range on VKA therapy is an important predictor of major haemorrhage.
“TTR on VKA therapy is an important predictor of major haemorrhage.432,441,494”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [441]
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- Authors
- Wan, Y., Heneghan, C., Perera, R., Roberts, N., Hollowell, J., Glasziou, P., Bankhead, C., & Xu, Y.
- Affiliations
- University of Oxford (GB)
- ORCID
- Venue
- Circulation Cardiovascular Quality and Outcomes
- Published
- 2008-11
- Volume
- 1
- Issue
- 2
- Pages
- 84-91
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- OpenAlex
- W2548706052
- Cited by
- 514
- References
- 51
- Citations by year
- 2026: 13 · 2025: 10 · 2024: 14 · 2023: 14 · 2022: 24 · 2021: 28 · 2020: 16 · 2019: 20 · 2018: 29 · 2017: 50 · 2016: 59 · 2015: 64 · 2014: 57 · 2013: 40 · 2012: 37
- FWCI
- 9.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research
- National Natural Science Foundation of China
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Keywords
- atrial fibrillation, oral anticoagulation, vitamin K antagonists, international normalized ratio, INR control, time in therapeutic range, major bleeding, thromboembolic events, adverse event prediction
- MeSH terms
- Administration, Oral, Anticoagulants, Atrial Fibrillation, Blood Coagulation, Clinical Trials as Topic, Hemorrhage, Humans, Prognosis, Time Factors, Vitamin K
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