Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Trends in Oral Anticoagulation Therapy Among Korean Patients With Atrial Fibrillation: The KORean Atrial Fibrillation Investigation

  • Shin, Hong-Won (Department of Cardiology, Keimyung University Dongsan Medical Center) ;
  • Kim, Yoon-Nyun (Department of Cardiology, Keimyung University Dongsan Medical Center) ;
  • Bae, Han-Jun (Department of Cardiology, Keimyung University Dongsan Medical Center) ;
  • Lee, Ho-Myung (Department of Cardiology, Keimyung University Dongsan Medical Center) ;
  • Cho, Hyun-Ok (Department of Cardiology, Keimyung University Dongsan Medical Center) ;
  • Cho, Yun-Kyeong (Department of Cardiology, Keimyung University Dongsan Medical Center) ;
  • Park, Hyoung-Seob (Department of Cardiology, Keimyung University Dongsan Medical Center) ;
  • Yoon, Hyuck-Jun (Department of Cardiology, Keimyung University Dongsan Medical Center) ;
  • Kim, Hyung-Seop (Department of Cardiology, Keimyung University Dongsan Medical Center) ;
  • Nam, Chang-Wook (Department of Cardiology, Keimyung University Dongsan Medical Center) ;
  • Hur, Seung-Ho (Department of Cardiology, Keimyung University Dongsan Medical Center) ;
  • Kim, Kwon-Bae (Department of Cardiology, Keimyung University Dongsan Medical Center) ;
  • Lee, Young-Soo (Department of Cardiology, Daegu Catholic University Medical Center) ;
  • KORAF Investigator, (KORAF Investigator)
  • Published : 2012.02.29
⟨ Previous Next ⟩

Abstract

Background and Objectives: Anticoagulation with vitamin K antagonists (VKAs) such as warfarin provides effective stroke prophylaxis in patients with atrial fibrillation (AF). We conducted a large multicenter survey of Korean patients with AF to determine trends in VKA use. Subjects and Methods: Eligible patients were adults with AF that had been prescribed VKAs. Medical records from a total of 5616 patients {mean age 63.6${\pm}$12.2 years, male 3150 (56.1%)} in 27 hospitals from Jan. 2001 to Oct. 2007 were reviewed. Results: The mean international normalized ratio (INR) was 2.04${\pm}$0.64, and mean dosage of VKA was 3.66${\pm}$1.50 mg. Individuals in their sixties (1852 patients) accounted for about one third of patients studied. As patients grew older, INR increased and VKA dosage decreased. The dosage of VKA in male patients was larger than that in females for all ages. A total of 2146 (42.4%) patients had an INR of 2-3, and less than 40% patients in their sixties had an INR within optimal range. The dosage of oral anticoagulant for optimal INR level was 3.71 mg. Conclusion: In this study, less than half of the Korean patients with AF on VKA reached the therapeutic range of INR. Mean dosage of VKA was 3.66${\pm}$1.50 mg, and the dosage of oral anticoagulant for optimal INR level was 3.71 mg, which decreased with age.

Keywords

References

  1. Singer DE, Albers GW, Dalen JE, et al. Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133(6 Suppl): 546S-92S. https://doi.org/10.1378/chest.08-0678
  2. Fuster V, Ryden LE, Cannom DS, et al. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol 2011;57:e101-98.
  3. Lip GY, Agnelli G, Thach AA, Knight E, Rost D, Tangelder MJ. Oral anticoagulation in atrial fibrillation: a pan-European patient survey. Eur J Intern Med 2007;18:202-8. https://doi.org/10.1016/j.ejim.2006.11.005
  4. Ansell J, Hirsh J, Poller L, Bussey H, Jacobson A, Hylek E. The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(3 Suppl):204S-33S. https://doi.org/10.1378/chest.126.3_suppl.204S
  5. Lee KS, Choi SJ, Park SH, Kim HL, Min H, Park HY. Prevalence of atrial fibrillation in middle-aged people in Korea: the Korean Genome and Epidemiology Study. Korean Circ J 2008;38:601-5. https://doi.org/10.4070/kcj.2008.38.11.601
  6. Shen AY, Chen W, Yao JF, Brar SS, Wang X, Go AS. Effect of race/ethnicity on the efficacy of warfarin: potential implications for prevention of stroke in patients with atrial fibrillation. CNS Drugs 2008;22:815-25. https://doi.org/10.2165/00023210-200822100-00003
  7. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly: the Framingham Study. Arch Intern Med 1987; 147:1561-4. https://doi.org/10.1001/archinte.1987.00370090041008
  8. Laupacis A, Boysen G, Connolly S, et al. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. Arch Intern Med 1994;154:1449-57. https://doi.org/10.1001/archinte.1994.00420130036007
  9. Kim YH. Rhythm control versus rate control of atrial fibrillation: pharmacologic and non-pharmacologic therapy. Korean Circ J 2003;33: 553-8.
  10. van Walraven C, Hart RG, Singer DE, et al. Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation: an individual patient meta-analysis. JAMA 2002;288:2441-8. https://doi.org/10.1001/jama.288.19.2441
  11. Hylek EM, Go AS, Chang Y, et al. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med 2003;349:1019-26. https://doi.org/10.1056/NEJMoa022913
  12. Waldo AL, Becker RC, Tapson VF, Colgan KJ; NABOR Steering Committee. Hospitalized patients with atrial fibrillation and a high risk of stroke are not being provided with adequate anticoagulation. J Am Coll Cardiol 2005;46:1729-36. https://doi.org/10.1016/j.jacc.2005.06.077
  13. Stansbury JP, Jia H, Williams LS, Vogel WB, Duncan PW. Ethnic disparities in stroke: epidemiology, acute care, and postacute outcomes. Stroke 2005;36:374-86. https://doi.org/10.1161/01.STR.0000153065.39325.fd
  14. van Walraven C, Jennings A, Oake N, Fergusson D, Forster AJ. Effect of study setting on anticoagulation control: a systematic review and metaregression. Chest 2006;129:1155-66. https://doi.org/10.1378/chest.129.5.1155
  15. Yasaka M, Minematsu K, Yamaquchi T. Optimal intensity of international normalized ratio in warfarin therapy for secondary prevention of stroke in patients with non-valvular atrial fibrillation. Intern Med 2001;40:1183-8. https://doi.org/10.2169/internalmedicine.40.1183
  16. Miura T, Nishinaka T, Terada T, Yonezawa K. Relationship between aging and dosage of warfarin: the current status of warfarin anticoagulant therapy for Japanese outpatients in a department of cardiovascular medicine. J Cardiol 2009;53:355-60. https://doi.org/10.1016/j.jjcc.2008.12.003
  17. Atarashi H, Inoue H, Okumura K, Yamashita T, Kumagai N, Origasa H; JRHYTHM Registry Investigators. Present status of anticoagulation treatment in Japanese patients with atrial fibrillation: a report from the J-RHYTHM Resistry. Circ J 2011;75:1328-33. https://doi.org/10.1253/circj.CJ-10-1119

Cited by

  1. Effect of Left Atrial Activity After the Maze Procedure on Clinical and Echocardiographic Outcomes vol.78, pp.7, 2012, https://doi.org/10.1253/circj.cj-13-1390
  2. INR optimization based on stroke risk factors in patients with non-valvular atrial fibrillation vol.37, pp.6, 2012, https://doi.org/10.1007/s11096-015-0149-5
  3. Quality of anticoagulation management with warfarin among outpatients in a tertiary hospital in Addis Ababa, Ethiopia: a retrospective cross-sectional study vol.17, pp.None, 2012, https://doi.org/10.1186/s12913-017-2330-0
  4. The Absence of Atrial Contraction as a Predictor of Permanent Pacemaker Implantation after Maze Procedure with Cryoablation vol.50, pp.3, 2017, https://doi.org/10.5090/kjtcs.2017.50.3.163
  5. 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 vol.35, pp.4, 2012, https://doi.org/10.1002/joa3.12183