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首页> 外文期刊>The American Journal of Cardiology >Effect of Temporary Interruption of Warfarin Due to an Intervention on Downstream Time in Therapeutic Range in Patients With Atrial Fibrillation (from ORBIT AF)
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Effect of Temporary Interruption of Warfarin Due to an Intervention on Downstream Time in Therapeutic Range in Patients With Atrial Fibrillation (from ORBIT AF)

机译：临时中断Warfarin的疗效由于心房颤动患者治疗范围中下游时间的干预（来自轨道AF）

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摘要

The aim of this study was to quantify time in therapeutic range (TTR) before and after a temporary interruption of warfarin due to an intervention in the Outcomes Registry for Better Informed Treatment of atrial fibrillation (AF). AF patients on warfarin who had a temporary interruption followed by resumption were identified. A nonparametric method for estimating survival functions for interval censored data was used to examine the first therapeutic International Normalized Ratio (INR) after interruption. TTR was compared using Wilcoxon signed rank test. Cox proportional hazards model was used to investigate the association between TTR in the first 3 months after interruption and subsequent outcomes at 3 to 9 months. Of 9,749 AF patients, 71% were on warfarin. Over a median (IQR) follow-up of 2.6 (1.8 to 3.1) y, 33% of patients had a total of 3,022 temporary interruptions. The first therapeutic INR was recorded within 1 week in 35.0% (95% confidence interval 32.6% to 37.4%), 2 weeks in 54.6% (52.2% to 57.0%), 30 days in 70.0% (67.9% to 72.1%) and 90 days in 91.3% (90.0% to 92.5%) of patients. Compared with pre-interruption, TTR 3 months after interruption was significantly lower (61.1% [36.6% to 85.0%] vs 67.6% [50.0% to 81.3%1, p <0.0001). A 10 unit increment in the TTR in the first 3 months after interruption was associated with a lower risk of major bleeding [Hazard ratio 0.91 (0.85 to 0.97), p = 0.005]. This association was noted in patients who received bridging anticoagulation, but not in those who did not. In conclusion, temporary interruption of warfarin is common, and nearly half of these patients had subtherapeutic INR after 2 weeks. Lower TTR in the first 3 months after interruption was associated with higher incidence of major bleeding in patients who received bridging anticoagulation. (C) 2020 Elsevier Inc. All rights reserved.
机译：这项研究的目的是量化在心房颤动（AF）的更知情治疗中，由于在结果登记处进行干预而暂时中断华法林治疗前后的治疗范围内时间（TTR）。发现服用华法林的房颤患者在恢复治疗后暂时中断治疗。使用非参数方法估计区间删失数据的生存函数，检查中断后的第一个治疗国际标准化比率（INR）。使用Wilcoxon符号秩检验比较TTR。Cox比例风险模型用于研究中断后前3个月的TTR与3至9个月的后续结果之间的关联。9749例房颤患者中，71%服用华法林。在2.6（1.8至3.1）年的中位（IQR）随访中，33%的患者共有3022次暂时中断。35.0%（95%可信区间32.6%至37.4%）的患者在1周内记录到首次治疗INR，54.6%（52.2%至57.0%）的患者在2周内记录到首次治疗INR，70.0%（67.9%至72.1%）的患者在30天内记录到首次治疗INR，91.3%（90.0%至92.5%）的患者在90天内记录到首次治疗INR。与中断前相比，中断后3个月的TTR显著降低（61.1%[36.6%至85.0%]vs 67.6%[50.0%至81.3%1，p<0.0001）。中断后前3个月TTR增加10个单位与大出血风险降低相关（危险比0.91（0.85至0.97），p=0.005）。在接受过桥抗凝治疗的患者中发现了这种关联，但在未接受过桥抗凝治疗的患者中没有发现这种关联。总之，华法林的暂时中断是常见的，近一半的患者在2周后出现亚治疗INR。中断后前3个月TTR较低与接受桥接抗凝治疗的患者大出血发生率较高相关。（C） 2020爱思唯尔公司版权所有。

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