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Bleeding complications and mortality in warfarin-treated VTE patients, dependence of INR variability and iTTR

Sandén, Per; Renlund, Henrik; Svensson, Peter J. LU and Själander, Anders (2017) In Thrombosis and Haemostasis 117(1). p.27-32
Abstract

High quality of warfarin treatment is important to prevent recurrence of venous thromboembolism (VTE) without bleeding complications. The aim of this study was to examine the effect of individual time in therapeutic range (iTTR) and International Normalised Ratio (INR) variability on bleeding risk and mortality in a large cohort of wellmanaged patients with warfarin due to VTE. A cohort of 16612 patients corresponding to 19502 treatment periods with warfarin due to VTE between January 1, 2006 and December 31, 2011 was retrieved from the Swedish national quality register AuriculA and matched with the Swedish National Patient Register for bleeding complications and background characteristics and the Cause of death register for occurrence... (More)

High quality of warfarin treatment is important to prevent recurrence of venous thromboembolism (VTE) without bleeding complications. The aim of this study was to examine the effect of individual time in therapeutic range (iTTR) and International Normalised Ratio (INR) variability on bleeding risk and mortality in a large cohort of wellmanaged patients with warfarin due to VTE. A cohort of 16612 patients corresponding to 19502 treatment periods with warfarin due to VTE between January 1, 2006 and December 31, 2011 was retrieved from the Swedish national quality register AuriculA and matched with the Swedish National Patient Register for bleeding complications and background characteristics and the Cause of death register for occurrence and date of death. The rate of bleeding was 1.79 (confidence interval (CI) 95 % 1.66-1.93) per 100 treatment years among all patients. Those with poor warfarin treatment quality had a higher rate of clinically relevant bleeding, both when measured as iTTR below 70 %, 2.91 (CI 95 % 2.61-3.21) or as INR variability over the mean value 0.85, 2.61 (CI 95 % 2.36-2.86). Among those with both high INR variability and low iTTR the risk of clinically relevant bleeding was clearly increased hazard ratio (HR) 3.47 (CI 95 % 2.89-4.17). A similar result was found for all-cause mortality with a HR of 3.67 (CI 95 % 3.02-4.47). Both a low iTTR and a high INR variability increase the risk of bleeding complications or mortality. When combining the two treatment quality indicators patients at particular high risk of bleeding or death can be identified.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Allcause mortality, Bleeding, INR variability, TTR, Venous thromboembolism, Warfarin
in
Thrombosis and Haemostasis
volume
117
issue
1
pages
6 pages
publisher
F K Schattauer Verlag Gmbh
external identifiers
  • scopus:85007321511
  • wos:000391350600006
ISSN
0340-6245
DOI
10.1160/TH16-06-0489
language
English
LU publication?
yes
id
f23fad1c-b9b3-4a73-a2f7-422e92505b62
date added to LUP
2017-01-13 13:48:10
date last changed
2018-06-10 05:14:41
@article{f23fad1c-b9b3-4a73-a2f7-422e92505b62,
  abstract     = {<p>High quality of warfarin treatment is important to prevent recurrence of venous thromboembolism (VTE) without bleeding complications. The aim of this study was to examine the effect of individual time in therapeutic range (iTTR) and International Normalised Ratio (INR) variability on bleeding risk and mortality in a large cohort of wellmanaged patients with warfarin due to VTE. A cohort of 16612 patients corresponding to 19502 treatment periods with warfarin due to VTE between January 1, 2006 and December 31, 2011 was retrieved from the Swedish national quality register AuriculA and matched with the Swedish National Patient Register for bleeding complications and background characteristics and the Cause of death register for occurrence and date of death. The rate of bleeding was 1.79 (confidence interval (CI) 95 % 1.66-1.93) per 100 treatment years among all patients. Those with poor warfarin treatment quality had a higher rate of clinically relevant bleeding, both when measured as iTTR below 70 %, 2.91 (CI 95 % 2.61-3.21) or as INR variability over the mean value 0.85, 2.61 (CI 95 % 2.36-2.86). Among those with both high INR variability and low iTTR the risk of clinically relevant bleeding was clearly increased hazard ratio (HR) 3.47 (CI 95 % 2.89-4.17). A similar result was found for all-cause mortality with a HR of 3.67 (CI 95 % 3.02-4.47). Both a low iTTR and a high INR variability increase the risk of bleeding complications or mortality. When combining the two treatment quality indicators patients at particular high risk of bleeding or death can be identified.</p>},
  author       = {Sandén, Per and Renlund, Henrik and Svensson, Peter J. and Själander, Anders},
  issn         = {0340-6245},
  keyword      = {Allcause mortality,Bleeding,INR variability,TTR,Venous thromboembolism,Warfarin},
  language     = {eng},
  month        = {01},
  number       = {1},
  pages        = {27--32},
  publisher    = {F K Schattauer Verlag Gmbh},
  series       = {Thrombosis and Haemostasis},
  title        = {Bleeding complications and mortality in warfarin-treated VTE patients, dependence of INR variability and iTTR},
  url          = {http://dx.doi.org/10.1160/TH16-06-0489},
  volume       = {117},
  year         = {2017},
}