Skip to main content
Journal cover image

Patients' time in therapeutic range on warfarin among US patients with atrial fibrillation: Results from ORBIT-AF registry.

Publication ,  Journal Article
Pokorney, SD; Simon, DN; Thomas, L; Fonarow, GC; Kowey, PR; Chang, P; Singer, DE; Ansell, J; Blanco, RG; Gersh, B; Mahaffey, KW; Hylek, EM ...
Published in: Am Heart J
July 2015

BACKGROUND: Time in therapeutic range (TTR) of international normalized ratio (INR) of 2.0 to 3.0 is important for the safety and effectiveness of warfarin anticoagulation. There are few data on TTR among patients with atrial fibrillation (AF) in community-based clinical practice. METHODS: Using the US Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), we examined TTR (using a modified Rosendaal method) among 5,210 patients with AF on warfarin and treated at 155 sites. Patients were grouped into quartiles based on TTR data. Multivariable logistic regression modeling with generalized estimating equations was used to determine patient and provider factors associated with the lowest (worst) TTR. RESULTS: Overall, 59% of the measured INR values were between 2.0 and 3.0, with an overall mean and median TTR of 65% ± 20% and 68% (interquartile range [IQR] 53%-79%). The median times below and above the therapeutic range were 17% (IQR 8%-29%) and 10% (IQR 3%-19%), respectively. Patients with renal dysfunction, advanced heart failure, frailty, prior valve surgery, and higher risk for bleeding (ATRIA score) or stroke (CHA2DS2-VASc score) had significantly lower TTR (P < .0001 for all). Patients treated at anticoagulation clinics had only slightly higher median TTR (69%) than those not (66%) (P < .0001). CONCLUSIONS: Among patients with AF in US clinical practices, TTR on warfarin is suboptimal, and those at highest predicted risks for stroke and bleeding were least likely to be in therapeutic range.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

July 2015

Volume

170

Issue

1

Start / End Page

141 / 148.e1

Location

United States

Related Subject Headings

  • Warfarin
  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Registries
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Pokorney, S. D., Simon, D. N., Thomas, L., Fonarow, G. C., Kowey, P. R., Chang, P., … Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators, . (2015). Patients' time in therapeutic range on warfarin among US patients with atrial fibrillation: Results from ORBIT-AF registry. Am Heart J, 170(1), 141-148.e1. https://doi.org/10.1016/j.ahj.2015.03.017
Pokorney, Sean D., DaJuanicia N. Simon, Laine Thomas, Gregg C. Fonarow, Peter R. Kowey, Paul Chang, Daniel E. Singer, et al. “Patients' time in therapeutic range on warfarin among US patients with atrial fibrillation: Results from ORBIT-AF registry.Am Heart J 170, no. 1 (July 2015): 141-148.e1. https://doi.org/10.1016/j.ahj.2015.03.017.
Pokorney SD, Simon DN, Thomas L, Fonarow GC, Kowey PR, Chang P, et al. Patients' time in therapeutic range on warfarin among US patients with atrial fibrillation: Results from ORBIT-AF registry. Am Heart J. 2015 Jul;170(1):141-148.e1.
Pokorney, Sean D., et al. “Patients' time in therapeutic range on warfarin among US patients with atrial fibrillation: Results from ORBIT-AF registry.Am Heart J, vol. 170, no. 1, July 2015, pp. 141-148.e1. Pubmed, doi:10.1016/j.ahj.2015.03.017.
Pokorney SD, Simon DN, Thomas L, Fonarow GC, Kowey PR, Chang P, Singer DE, Ansell J, Blanco RG, Gersh B, Mahaffey KW, Hylek EM, Go AS, Piccini JP, Peterson ED, Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators. Patients' time in therapeutic range on warfarin among US patients with atrial fibrillation: Results from ORBIT-AF registry. Am Heart J. 2015 Jul;170(1):141-148.e1.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

July 2015

Volume

170

Issue

1

Start / End Page

141 / 148.e1

Location

United States

Related Subject Headings

  • Warfarin
  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Risk Factors
  • Renal Insufficiency, Chronic
  • Registries
  • Middle Aged
  • Male