title: Quality of Anticoagulation With Vitamin K Antagonists.
abstract: BACKGROUND
  Vitamin K antagonists (VKA) have a narrow therapeutic range, and literature analysis reveals poor quality of anticoagulation control. We sought to assess the prevalence of poor anticoagulant control in patients under VKA treatment in the prevention of stroke for atrial fibrillation (AF).
  
  
  OBJECTIVE
  Control of anticoagulation with VKA is inadequate in a high percentage of patients with AF.
  
  
  METHODS
  Patients with AF under VKA treatment were prospectively recruited in this observational registry. The sample comprised 948 patients. The estimated time spent in the therapeutic range (TTR) was calculated, and variables related with a TTR >65% were analyzed.
  
  
  RESULTS
  Mean age was 73.8 ± 9.4 years, and 42.5% of the patients were women. Mean TTR was 63.77% ± 23.80% for the direct method and 60.27% ± 24.48% for the Rosendaal method. Prevalence of poor anticoagulation control was 54%. Variables associated with good anticoagulation control were university studies (odds ratio [OR]: 1.99, 95% confidence interval [CI]: 1.08-3.64), chronic hepatic disease (OR: 8.15, 95% CI: 1.57-42.24), low comorbidity expressed as Charlson index (OR: 0.87, 95% CI: 0.76-0.99), no previous cardiac disease (OR: 0.64, 95% CI: 0.41-0.98), lower risk of bleeding assessed as hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly age, and use of drugs or alcohol (HAS-BLED; OR: 0.81, 95% CI: 0.69-0.95), and lower heart rate (OR: 0.99, 95% CI: 0.98-0.99).
  
  
  CONCLUSIONS
  Patients who receive VKA to prevent stroke for AF spend less than half the time within therapeutic range.
authors.affiliation: Department of Cardiology, San Juan University Hospital, Miguel Hernández University, Alicante, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-González
authors.affiliation: Department of Cardiology, Research Agency of the Spanish Society of Cardiology, Madrid, Spain.|Department of Cardiology, University Hospital Reina Sofía, Córdoba, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Anguita
authors.affiliation: Department of Cardiology, San Juan University Hospital, Miguel Hernández University, Alicante, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Moreno-Arribas
authors.affiliation: Department of Cardiology, Research Agency of the Spanish Society of Cardiology, Madrid, Spain.|Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Cequier
authors.affiliation: Department of Cardiology, University Institute in Health Sciences, University of A Coruña, A Coruña Biomedical Research Institute, A Coruña, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Muñiz
authors.affiliation: Department of Cardiology, San Juan University Hospital, Miguel Hernández University, Alicante, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Castillo-Castillo
authors.affiliation: Department of Cardiology, Hospital Clinic of València, University of Valencia, Valencia, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.affiliation: Department of Cardiology, University Hospital La Paz, Madrid, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Roldán
authors.affiliation: Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Marin
authors.affiliation: Department of Cardiology, San Juan University Hospital, Miguel Hernández University, Alicante, Spain.|Department of Cardiology, Research Agency of the Spanish Society of Cardiology, Madrid, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-Martínez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care; D012042:Registries; D020521:Stroke / Q000517:prevention & control; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K