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, huinam 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 KimMinsoo 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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International Normalized Ratio
Vitamin K
Atrial Fibrillation
Registries
Therapeutics
Platelet Aggregation Inhibitors
Hemorrhage
Observational Studies

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Park, Hee Soon ; Kim, Young Hoon ; Kim, June Soo ; Oh, Yong Seog ; Shin, Dong Gu ; pak, huinam ; Hwang, Gyo Seung ; Choi, Kee Joon ; Oh, Seil ; Kim, Jin Bae ; Lee, Man Young ; Park, Hyung Wook ; Kim, Dae Kyeong ; Jin, Eun Sun ; Park, Jae Seok ; Oh, Il Young ; Shin, Dae Hee ; Park, Hyoung Seob ; Kim, Jun Hyung ; Kim, Nam Ho ; Ahn, Minsoo ; Seo, Bo Jeong ; Kim, Young Joo ; Kang, Seongsik ; Lee, Juneyoung. / 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. In: journal of arrhythmia. 2019 ; Vol. 35, No. 4. pp. 593-601.
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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.",
author = "Park, {Hee Soon} and Kim, {Young Hoon} and Kim, {June Soo} and Oh, {Yong Seog} and Shin, {Dong Gu} and huinam pak and Hwang, {Gyo Seung} and Choi, {Kee Joon} and Seil Oh and Kim, {Jin Bae} and Lee, {Man Young} and Park, {Hyung Wook} and Kim, {Dae Kyeong} and Jin, {Eun Sun} and Park, {Jae Seok} and Oh, {Il Young} and Shin, {Dae Hee} and Park, {Hyoung Seob} and Kim, {Jun Hyung} and Kim, {Nam Ho} and Minsoo Ahn and Seo, {Bo Jeong} and Kim, {Young Joo} and Seongsik Kang and Juneyoung Lee",
year = "2019",
month = "1",
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doi = "10.1002/joa3.12183",
language = "English",
volume = "35",
pages = "593--601",
journal = "Journal of Arrhythmia",
issn = "1880-4276",
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Park, HS, Kim, YH, Kim, JS, Oh, YS, Shin, DG, pak, H, Hwang, GS, Choi, KJ, Oh, S, Kim, JB, Lee, MY, Park, HW, Kim, DK, Jin, ES, Park, JS, Oh, IY, Shin, DH, Park, HS, Kim, JH, Kim, NH, Ahn, M, Seo, BJ, Kim, YJ, Kang, S & 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, vol. 35, no. 4, pp. 593-601. https://doi.org/10.1002/joa3.12183

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

In: journal of arrhythmia, Vol. 35, No. 4, 01.01.2019, p. 593-601.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Status of international normalized ratio control and treatment patterns in patients with nonvalvular atrial fibrillation taking vitamin K antagonist with or without antiplatelet therapy

T2 - Results from KORAFII registry

AU - Park, Hee Soon

AU - Kim, Young Hoon

AU - Kim, June Soo

AU - Oh, Yong Seog

AU - Shin, Dong Gu

AU - pak, huinam

AU - Hwang, Gyo Seung

AU - Choi, Kee Joon

AU - Oh, Seil

AU - Kim, Jin Bae

AU - Lee, Man Young

AU - Park, Hyung Wook

AU - Kim, Dae Kyeong

AU - Jin, Eun Sun

AU - Park, Jae Seok

AU - Oh, Il Young

AU - Shin, Dae Hee

AU - Park, Hyoung Seob

AU - Kim, Jun Hyung

AU - Kim, Nam Ho

AU - Ahn, Minsoo

AU - Seo, Bo Jeong

AU - Kim, Young Joo

AU - Kang, Seongsik

AU - Lee, Juneyoung

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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