Clinical outcome in Japanese elderly patients with non-valvular atrial fibrillation taking warfarin

A single-center observational study

Miyoko Naganuma, Tsuyoshi Shiga, Kumi Sato, Kagari Murasaki, Masayuki Hashiguchi, Mayumi Mochizuki, Nobuhisa Hagiwara

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: Although a lower target prothrombin time-international normalized ratio (PT-INR) with warfarin therapy is recommended in Japan for atrial fibrillation (AF) patients ≥ 70 years of age, few studies have provided supporting data. The current study aimed to evaluate the clinical outcome in elderly Japanese patients with non-valvular AF who were taking warfarin. Methods: We conducted a cohort study of 845 consecutive non-valvular AF patients ≥ 70 years of age who were taking warfarin (median age, 74 years; 30.5% women) with a median follow-up period of 27 months (4-69 months). Of these patients, 29.7% had a history of stoke/transient ischemic attack (TIA), and 73.1% of the patients had a CHADS 2 score ≥ 2. The occurrence of thromboembolic events, including ischemic stroke, TIA and other systemic embolisms, and major bleeding events were validated through a review of medical records. Results: The incidence of thromboembolic and major bleeding events were 3.8 and 2.1% per year, respectively. A higher incidence of both events was observed in patients with a CHADS 2 score ≥ 3. The multivariate analysis showed that prior stroke/TIA (odds ratio 1.7, 95% CI 1.0-2.7) and diabetes (odds ratio 1.7, 95% CI 1.0-2.8) were independent risks of thromoembolic events. A HAS-BLED score ≥ 3 represented a risk for major bleeding (hazard ratio 2.8, 95% CI 1.7-4.6). A PT-INR of 1.5-2.5 indicated a low incidence of thromboembolic and major bleeding events in patients with a CHADS 2 score ≥ 2. Conclusions: Our results demonstrate that a target PT-INR of 2.0 and a range of 1.5-2.5 may be safe for elderly Japanese patients with non-valvular AF.

Original languageEnglish
Pages (from-to)21-26
Number of pages6
JournalThrombosis Research
Volume130
Issue number1
DOIs
Publication statusPublished - 2012 Jul

Fingerprint

Warfarin
Atrial Fibrillation
Observational Studies
International Normalized Ratio
Prothrombin Time
Transient Ischemic Attack
Hemorrhage
Incidence
Stroke
Odds Ratio
Embolism
Medical Records
Japan
Cohort Studies
Multivariate Analysis

Keywords

  • atrial fibrillation
  • bleeding
  • elderly
  • Japanese
  • stroke
  • warfarin

ASJC Scopus subject areas

  • Hematology

Cite this

Clinical outcome in Japanese elderly patients with non-valvular atrial fibrillation taking warfarin : A single-center observational study. / Naganuma, Miyoko; Shiga, Tsuyoshi; Sato, Kumi; Murasaki, Kagari; Hashiguchi, Masayuki; Mochizuki, Mayumi; Hagiwara, Nobuhisa.

In: Thrombosis Research, Vol. 130, No. 1, 07.2012, p. 21-26.

Research output: Contribution to journalArticle

Naganuma, Miyoko ; Shiga, Tsuyoshi ; Sato, Kumi ; Murasaki, Kagari ; Hashiguchi, Masayuki ; Mochizuki, Mayumi ; Hagiwara, Nobuhisa. / Clinical outcome in Japanese elderly patients with non-valvular atrial fibrillation taking warfarin : A single-center observational study. In: Thrombosis Research. 2012 ; Vol. 130, No. 1. pp. 21-26.
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AU - Murasaki, Kagari

AU - Hashiguchi, Masayuki

AU - Mochizuki, Mayumi

AU - Hagiwara, Nobuhisa

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AB - Background: Although a lower target prothrombin time-international normalized ratio (PT-INR) with warfarin therapy is recommended in Japan for atrial fibrillation (AF) patients ≥ 70 years of age, few studies have provided supporting data. The current study aimed to evaluate the clinical outcome in elderly Japanese patients with non-valvular AF who were taking warfarin. Methods: We conducted a cohort study of 845 consecutive non-valvular AF patients ≥ 70 years of age who were taking warfarin (median age, 74 years; 30.5% women) with a median follow-up period of 27 months (4-69 months). Of these patients, 29.7% had a history of stoke/transient ischemic attack (TIA), and 73.1% of the patients had a CHADS 2 score ≥ 2. The occurrence of thromboembolic events, including ischemic stroke, TIA and other systemic embolisms, and major bleeding events were validated through a review of medical records. Results: The incidence of thromboembolic and major bleeding events were 3.8 and 2.1% per year, respectively. A higher incidence of both events was observed in patients with a CHADS 2 score ≥ 3. The multivariate analysis showed that prior stroke/TIA (odds ratio 1.7, 95% CI 1.0-2.7) and diabetes (odds ratio 1.7, 95% CI 1.0-2.8) were independent risks of thromoembolic events. A HAS-BLED score ≥ 3 represented a risk for major bleeding (hazard ratio 2.8, 95% CI 1.7-4.6). A PT-INR of 1.5-2.5 indicated a low incidence of thromboembolic and major bleeding events in patients with a CHADS 2 score ≥ 2. Conclusions: Our results demonstrate that a target PT-INR of 2.0 and a range of 1.5-2.5 may be safe for elderly Japanese patients with non-valvular AF.

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