Status of international normalized ratio control and treatment patterns in patients with nonvalvular atrial fibrillation taking vitamin K antagonist with or without antiplatelet therapy: Results from KORAFII registry

Hee Soon Park, Young Hoon Kim, June Soo Kim, Yong Seog Oh, Dong Gu Shin, Hui Nam Pak, Gyo Seung Hwang, Kee Joon Choi, Seil Oh, Jin Bae Kim, Man Young Lee, Hyung Wook Park, Dae Kyeong Kim, Eun Sun Jin, Jae Seok Park, Il Young Oh, Dae Hee Shin, Hyoung Seob Park, Jun Hyung Kim, Nam Ho KimMin Soo Ahn, Bo Jeong Seo, Young Joo Kim, Seongsik Kang, Juneyoung Lee

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Abstract

Background: Studies have shown that the concomitant use of a vitamin K antagonist (VKA) and an antiplatelet (APL) drug increased the bleeding risk and was less effective at preventing ischemic events. This study aimed to investigate the control status of international normalized ratio (INR) and the discontinuation rate of a VKA in patients taking VKA plus an APL drug compared with those taking a VKA alone. Methods: Data were extracted from the KORean Atrial Fibrillation Investigation II registry, a multicenter noninterventional prospective observational study. Nonvalvular atrial fibrillation (NVAF) patients with CHADS2 scores ≥ 1 who newly started (within 3 months) a VKA were enrolled and followed up for 1 year. Results: A total of 866 NVAF patients (mean age, 67.7 years; 60.3% men) without a bleeding history were divided into the VKA+APL (n = 229) and VKA alone (n = 637) groups. During follow-up, mean INR level was lower in the VKA+APL group than in the VKA alone group (1.7 ± 0.8 vs 1.9 ± 0.9, P = 0.0005). INR levels were poorly controlled in both groups (66.1% and 64.7%, respectively). Patients in the VKA+APL group more frequently discontinued VKA than patients in the VKA alone group (28.8% vs 24.2%, P = 0.045). Major causes of VKA discontinuation were uncontrolled INR level and patient dissatisfaction or concerns. Conclusions: The conditions of NVAF patients were inadequately controlled with VKA with or without an APL. These findings suggest that other antithrombotic treatment options are warranted in NVAF patients to achieve INR control.

Original languageEnglish
Pages (from-to)593-601
Number of pages9
Journaljournal of arrhythmia
Volume35
Issue number4
DOIs
Publication statusPublished - 2019 Jan 1

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All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Park, H. S., Kim, Y. H., Kim, J. S., Oh, Y. S., Shin, D. G., Pak, H. N., Hwang, G. S., Choi, K. J., Oh, S., Kim, J. B., Lee, M. Y., Park, H. W., Kim, D. K., Jin, E. S., Park, J. S., Oh, I. Y., Shin, D. H., Park, H. S., Kim, J. H., ... Lee, J. (2019). Status of international normalized ratio control and treatment patterns in patients with nonvalvular atrial fibrillation taking vitamin K antagonist with or without antiplatelet therapy: Results from KORAFII registry. journal of arrhythmia, 35(4), 593-601. https://doi.org/10.1002/joa3.12183