Anticoagulation Stability Depends on CHADS2Score and Hepatorenal Function in Warfarin-treated Patients, Including Those with Atrial Fibrillation.
OBJECTIVE
Although warfarin remains important despite the widespread use of nonvitamin K antagonist oral anticoagulants (NOACs), to date, the reality of warfarin use in the "NOACs era" is unclear. This multicenter observational study aimed to clarify the key factors contributing to warfarin treatment stability.


METHODS
The practical use of warfarin, stability of warfarin therapy, and factors contributing to this stability were investigated in community-based hospitals through a real-world study. Clinical data were retrospectively extracted from the medical records of warfarin-treated Japanese patients (age, 71.3±5.5 years) with atrial fibrillation (AF), prosthetic heart valve, or other concerns requiring anticoagulation. Treatment stability was considered as time in therapeutic range of international normalized ratio of prothrombin time (TTR: %). The factors contributing to TTR were investigated, including CHADS2score components.


RESULTS
Mean CHADS2score was highest (1.38±0.88, p＜0.001), and most CHADS2score components in addition to hepatorenal dysfunction were factors contributing to the low TTR in patients with AF (n=176). The similarity was found in overall patients who were prescribed warfarin (n= 518). TTR decreased according to the CHADS2score component accumulation. Gender, dose and prescription interval of warfarin, and co-administration of antiplatelet agents did not correlate with the low TTR.


CONCLUSIONS
This retrospective study demonstrated that the CHADS2score component accumulation and hepatorenal dysfunction are factors significantly contributing to the low TTR, which is indicative of poor warfarin treatment stability, in patients such as those with AF.
Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences.
Keita
K
Odashiro
Taku
T
Yokoyama
Mitsuhiro
M
Fukata
Takeshi
T
Arita
Toru
T
Maruyama
Koichi
K
Akashi
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D015415:Biomarkers / Q000032:analysis; D001777:Blood Coagulation / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006530:Hepatorenal Syndrome / Q000503:physiopathology*; D006801:Humans; D007677:Kidney Function Tests; D008111:Liver Function Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D015415:Biomarkers; D014859:Warfarin