Percentage of time in therapeutic range and proportion of thromboembolic event in nonvalvular atrial fibrillation patient on warfarin

Background Atrial fibrillation ( AF ) is the most common sustained cardiac arrhythmia. The use of warfarin reduces the rate of ischemic stroke in patients with nonvalvular AF, but requires frequent monitoring and dose adjustment. Target INR are frequently not achieved, and the risk of thrombosis...

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Main Author:	Mohd, Fahmi Nazrin
Format:	Thesis
Language:	English
Published:	2015
Subjects:	RC666-701 Diseases of the circulatory (Cardiovascular) system
Online Access:	http://eprints.usm.my/39775/1/Dr_Fahmi_Nazrin_Mohd__%28Internal_Medicine%29-24_pages.pdf
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spelling	my-usm-ep.397752019-04-12T05:25:55Z Percentage of time in therapeutic range and proportion of thromboembolic event in nonvalvular atrial fibrillation patient on warfarin 2015 Mohd, Fahmi Nazrin RC666-701 Diseases of the circulatory (Cardiovascular) system Background Atrial fibrillation ( AF ) is the most common sustained cardiac arrhythmia. The use of warfarin reduces the rate of ischemic stroke in patients with nonvalvular AF, but requires frequent monitoring and dose adjustment. Target INR are frequently not achieved, and the risk of thrombosis, bleeding and death may be related to INR control. Methods : We analyzed the relationship between the INR control and the proportion of thromboembolic event, bleeding and clinical factors associated with time in therapeutic range ( TTR ) , among 73 patients with nonvalvular atrial fibrillation. Patient were divided into 2 groups ( those with good control TTR ≥ 60% and those with poor control TTR < 60 % ), according to the percentage time with an INR of 2.0 to 3.0. Outcomes were compared according to INR control. The main outcome measures were thrombotic event, and bleeding. Result : The mean TTR in Kelantan patient is 40% with poor control group had higher rates of bleeding ( odds ratio, 5.01; 95% CI 1.30 to 19.39; p = 0.02 ) compared with the good control group. Several clinical factors were identified incliding triglyceride ( odds ratio, 10.60;95% CI 1.64 to 68.39; p = 0.013 ), type of AF – permanent ( odds ratio, 6.81; 95% CI 1.22 to 38.11; p = 0.029 ) and bleeding ( odds ratio, 9.98; 95% CI 1.65 to 60.22; p = 0.012 ) significantly associated with TTR < 60%. Conclusion : In patient with nonvalvular atrial fibrillation taking warfarin, the risk of bleeding is related to poor control of TTR. Good INR control is important to improve patient outcome. 2015 Thesis http://eprints.usm.my/39775/ http://eprints.usm.my/39775/1/Dr_Fahmi_Nazrin_Mohd__%28Internal_Medicine%29-24_pages.pdf application/pdf en public masters Universiti Sains Malaysia Pusat Pengajian Sains Perubatan
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	RC666-701 Diseases of the circulatory (Cardiovascular) system
spellingShingle	RC666-701 Diseases of the circulatory (Cardiovascular) system Mohd, Fahmi Nazrin Percentage of time in therapeutic range and proportion of thromboembolic event in nonvalvular atrial fibrillation patient on warfarin
description	Background Atrial fibrillation ( AF ) is the most common sustained cardiac arrhythmia. The use of warfarin reduces the rate of ischemic stroke in patients with nonvalvular AF, but requires frequent monitoring and dose adjustment. Target INR are frequently not achieved, and the risk of thrombosis, bleeding and death may be related to INR control. Methods : We analyzed the relationship between the INR control and the proportion of thromboembolic event, bleeding and clinical factors associated with time in therapeutic range ( TTR ) , among 73 patients with nonvalvular atrial fibrillation. Patient were divided into 2 groups ( those with good control TTR ≥ 60% and those with poor control TTR < 60 % ), according to the percentage time with an INR of 2.0 to 3.0. Outcomes were compared according to INR control. The main outcome measures were thrombotic event, and bleeding. Result : The mean TTR in Kelantan patient is 40% with poor control group had higher rates of bleeding ( odds ratio, 5.01; 95% CI 1.30 to 19.39; p = 0.02 ) compared with the good control group. Several clinical factors were identified incliding triglyceride ( odds ratio, 10.60;95% CI 1.64 to 68.39; p = 0.013 ), type of AF – permanent ( odds ratio, 6.81; 95% CI 1.22 to 38.11; p = 0.029 ) and bleeding ( odds ratio, 9.98; 95% CI 1.65 to 60.22; p = 0.012 ) significantly associated with TTR < 60%. Conclusion : In patient with nonvalvular atrial fibrillation taking warfarin, the risk of bleeding is related to poor control of TTR. Good INR control is important to improve patient outcome.
format	Thesis
qualification_level	Master's degree
author	Mohd, Fahmi Nazrin
author_facet	Mohd, Fahmi Nazrin
author_sort	Mohd, Fahmi Nazrin
title	Percentage of time in therapeutic range and proportion of thromboembolic event in nonvalvular atrial fibrillation patient on warfarin
title_short	Percentage of time in therapeutic range and proportion of thromboembolic event in nonvalvular atrial fibrillation patient on warfarin
title_full	Percentage of time in therapeutic range and proportion of thromboembolic event in nonvalvular atrial fibrillation patient on warfarin
title_fullStr	Percentage of time in therapeutic range and proportion of thromboembolic event in nonvalvular atrial fibrillation patient on warfarin
title_full_unstemmed	Percentage of time in therapeutic range and proportion of thromboembolic event in nonvalvular atrial fibrillation patient on warfarin
title_sort	percentage of time in therapeutic range and proportion of thromboembolic event in nonvalvular atrial fibrillation patient on warfarin
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan
publishDate	2015
url	http://eprints.usm.my/39775/1/Dr_Fahmi_Nazrin_Mohd__%28Internal_Medicine%29-24_pages.pdf
_version_	1747820768925843456

Percentage of time in therapeutic range and proportion of thromboembolic event in nonvalvular atrial fibrillation patient on warfarin

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