du.sePublikationer
Ändra sökning
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • chicago-author-date
  • chicago-note-bibliography
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Time in therapeutic range and outcomes after warfarin initiation in newly diagnosed atrial fibrillation patients with renal dysfunction
Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala university.ORCID-id: 0000-0002-6933-4637
Visa övriga samt affilieringar
2017 (Engelska)Ingår i: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 6, nr 3, artikel-id e004925Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: It is unknown whether renal dysfunction conveys poor anticoagulation control in warfarin-treated patients with atrial fibrillation and whether poor anticoagulation control associates with the risk of adverse outcomes in these patients.

METHODS AND RESULTS: This was an observational study from the Stockholm CREatinine Measurements (SCREAM) cohort including all newly diagnosed atrial fibrillation patients initiating treatment with warfarin (n=7738) in Stockholm, Sweden, between 2006 and 2011. Estimated glomerular filtration rate (eGFR; mL/min per 1.73 m(2)) was calculated from serum creatinine. Time-in-therapeutic range (TTR) was assessed from international normalized ratio (INR) measurements up to warfarin cessation, adverse event, or end of follow-up (2 years). Adverse events considered a composite of intracranial hemorrhage, ischemic stroke, myocardial infarction, or death. During median 254 days, TTR was 83%, based on median 21 INR measurements per patient. TTR was 70% among patients with eGFR <30, around 10% lower than in those with normal renal function. During observation, adverse events occurred in 4.0% of patients, and those with TTR ≤75% were at higher adverse event risk. This was independent of patient characteristics, comorbidities, number of INR tests, days exposed to warfarin, and, notably, independent of eGFR: adjusted odds ratio (OR) 1.84 (95% CI, 1.41-2.40) for TTR 75% to 60% and adjusted OR 2.09 (1.59-2.74) for TTR <60%. No interaction was observed between eGFR and TTR in association to adverse events (P=0.2).

CONCLUSION: Severe chronic kidney disease (eGFR <30) patients with atrial fibrillation have worse INR control while on warfarin. An optimal TTR (>75%) is associated with lower risk of adverse events, independently of underlying renal function.

Ort, förlag, år, upplaga, sidor
2017. Vol. 6, nr 3, artikel-id e004925
Nyckelord [en]
all‐cause death, anticoagulant, atrial fibrillation, bleeding, ischemic stroke, renal function
Nationell ämneskategori
Klinisk medicin
Forskningsämne
Hälsa och välfärd
Identifikatorer
URN: urn:nbn:se:du-24516DOI: 10.1161/JAHA.116.004925ISI: 000399322900038PubMedID: 28249846OAI: oai:DiVA.org:du-24516DiVA, id: diva2:1079864
Tillgänglig från: 2017-03-09 Skapad: 2017-03-09 Senast uppdaterad: 2017-11-29Bibliografiskt granskad

Open Access i DiVA

fulltext(1513 kB)180 nedladdningar
Filinformation
Filnamn FULLTEXT01.pdfFilstorlek 1513 kBChecksumma SHA-512
95f5e68a37670ac8ec5a3134f7a09ff67c0a2e2c019d0f09fcdd7a4b7c22fb147f0db9a99f32b57186bf6aab2187c9e1441f45743f700bcf8021ff6bb8bc6139
Typ fulltextMimetyp application/pdf

Övriga länkar

Förlagets fulltextPubMed

Personposter BETA

Ärnlöv, Johan

Sök vidare i DiVA

Av författaren/redaktören
Ärnlöv, Johan
Av organisationen
Medicinsk vetenskap
I samma tidskrift
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
Klinisk medicin

Sök vidare utanför DiVA

GoogleGoogle Scholar
Totalt: 180 nedladdningar
Antalet nedladdningar är summan av nedladdningar för alla fulltexter. Det kan inkludera t.ex tidigare versioner som nu inte längre är tillgängliga.

doi
pubmed
urn-nbn

Altmetricpoäng

doi
pubmed
urn-nbn
Totalt: 154 träffar
RefereraExporteraLänk till posten
Permanent länk

Direktlänk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • chicago-author-date
  • chicago-note-bibliography
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf