open access

Vol 24, No 5 (2017)
Original articles — Clinical cardiology
Published online: 2017-03-27
Get Citation

Prediction of unstable anticoagulation with acenocoumarol versus warfarin in atrial fibrillation

Agata Hanna Bryk, Krzysztof Plens, Anetta Undas
DOI: 10.5603/CJ.a2017.0038
·
Pubmed: 28353307
·
Cardiol J 2017;24(5):477-483.

open access

Vol 24, No 5 (2017)
Original articles — Clinical cardiology
Published online: 2017-03-27

Abstract

Background: The SAMe-TT2R2 (sex female, age, medical history, treatment, tobacco use, race) score was developed in patients with atrial fibrillation (AF) on warfarin. The present study aimed to 1) compare the anticoagulation quality and management of AF patients treated with warfarin with those on acenocoumarol and 2) optimize the SAMe-TT2R2 score to detect AF patients at high risk of unstable anticoagulation with acenocoumarol and warfarin.

Methods: In a single-center retrospective study, 320 patients with AF, including 15 (5%) after valve replacement, aged 40–82 (median 70) years, including 203 (63%) receiving acenocoumarol and 117 (37%) treated with warfarin, were studied. The SAMe-TT2R2 score was modified based on the candidate factors retrieved from univariate regression and assessed using the receiver operating curves (ROC).

Results: A median SAMe-TT2R2 score was 2 (1–3). Proportions of patients with ≥ 2 points and 0–1 points in the SAMe-TT2R2 score who had the time in therapeutic range (TTR) ≤ 70% were similar (61 [67%] vs. 63 [56%], p = 0.11). A modified score, involving medical history (myocardial infarction [MI] and chronic obstructive pulmonary disease [COPD], 1 point), statin treatment (1 point) and tobacco use (2 points) had a higher area under the curve (AUC) in patients on acenocoumarol compared to SAMe- TT2R2 (0.66; 95% confidence interval 0.58–0.73 vs. 0.56; 0.48–0.64, p = 0.042); ≥ 1 point indicated TTR > 70% with a sensitivity and specificity of 61% and 63%, respectively.

Conclusions: The SAMe-TT2R2 score is less effective in predicting unstable anticoagulation with acenocoumarol versus warfarin. Adding statin use and highlighting COPD and previous MI increases a predictive value of this score for acenocoumarol.  

Abstract

Background: The SAMe-TT2R2 (sex female, age, medical history, treatment, tobacco use, race) score was developed in patients with atrial fibrillation (AF) on warfarin. The present study aimed to 1) compare the anticoagulation quality and management of AF patients treated with warfarin with those on acenocoumarol and 2) optimize the SAMe-TT2R2 score to detect AF patients at high risk of unstable anticoagulation with acenocoumarol and warfarin.

Methods: In a single-center retrospective study, 320 patients with AF, including 15 (5%) after valve replacement, aged 40–82 (median 70) years, including 203 (63%) receiving acenocoumarol and 117 (37%) treated with warfarin, were studied. The SAMe-TT2R2 score was modified based on the candidate factors retrieved from univariate regression and assessed using the receiver operating curves (ROC).

Results: A median SAMe-TT2R2 score was 2 (1–3). Proportions of patients with ≥ 2 points and 0–1 points in the SAMe-TT2R2 score who had the time in therapeutic range (TTR) ≤ 70% were similar (61 [67%] vs. 63 [56%], p = 0.11). A modified score, involving medical history (myocardial infarction [MI] and chronic obstructive pulmonary disease [COPD], 1 point), statin treatment (1 point) and tobacco use (2 points) had a higher area under the curve (AUC) in patients on acenocoumarol compared to SAMe- TT2R2 (0.66; 95% confidence interval 0.58–0.73 vs. 0.56; 0.48–0.64, p = 0.042); ≥ 1 point indicated TTR > 70% with a sensitivity and specificity of 61% and 63%, respectively.

Conclusions: The SAMe-TT2R2 score is less effective in predicting unstable anticoagulation with acenocoumarol versus warfarin. Adding statin use and highlighting COPD and previous MI increases a predictive value of this score for acenocoumarol.  

Get Citation

Keywords

atrial fibrillation, anticoagulant therapy, acenocoumarol, warfarin

About this article
Title

Prediction of unstable anticoagulation with acenocoumarol versus warfarin in atrial fibrillation

Journal

Cardiology Journal

Issue

Vol 24, No 5 (2017)

Pages

477-483

Published online

2017-03-27

DOI

10.5603/CJ.a2017.0038

Pubmed

28353307

Bibliographic record

Cardiol J 2017;24(5):477-483.

Keywords

atrial fibrillation
anticoagulant therapy
acenocoumarol
warfarin

Authors

Agata Hanna Bryk
Krzysztof Plens
Anetta Undas

References (31)
  1. Schnabel RB, Yin X, Gona P, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015; 386(9989): 154–162.
  2. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38): 2893–2962.
  3. Gallagher AM, Setakis E, Plumb JM, et al. Risks of stroke and mortality associated with suboptimal anticoagulation in atrial fibrillation patients. Thromb Haemost. 2011; 106(5): 968–977.
  4. Kosior DA. Risk stratification schemes for stroke in atrial fibrillation: the predictive factors still undefined. Pol Arch Med Wewn. 2015; 125(12): 889–890.
  5. Apostolakis S, Sullivan RM, Olshansky B, et al. Factors affecting quality of anticoagulation control among patients with atrial fibrillation on warfarin: the SAMe-TT₂R₂ score. Chest. 2013; 144(5): 1555–1563.
  6. Atrial fibrillation follow-up investigation of rhythm management - the AFFIRM study design. The Planning and Steering Committees of the AFFIRM study for the NHLBI AFFIRM investigators. Am J Cardiol. 1997; 79(9): 1198–1202.
  7. Lobos-Bejarano JM, Barrios V, Polo-García J, et al. on behalf the PAULA Study Team. Evaluation of SAMe-TT2R2 score and other clinical factors influencing the quality of anticoagulation therapy in non-valvular atrial fibrillation: a nationwide study in Spain. Curr Med Res Opin. 2016; 32(7): 1201–1207.
  8. Pattacini C, Manotti C, Pini M, et al. A comparative study on the quality of oral anticoagulant therapy (warfarin versus acenocoumarol). Thromb Haemost. 1994; 71(2): 188–191.
  9. Wypasek E, Branicka A, Awsiuk M, et al. Genetic determinants of acenocoumarol and warfarin maintenance dose requirements in Slavic population: a potential role of CYP4F2 and GGCX polymorphisms. Thromb Res. 2014; 134(3): 604–609.
  10. Undas A, Cieśla-Dul M, Zółciński M, et al. Switching from acenocoumarol to warfarin in patients with unstable anticoagulation and its effect on anticoagulation control. Pol Arch Med Wewn. 2009; 119(6): 360–365.
  11. Camm AJ, Kirchhof P, Lip GYH, et al. Guidelines for the management of atrial fibrillation The Task Force for the Management of Atrial Fibrillation of the Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2010; 31(19): 2369–2429.
  12. 2. Classification and Diagnosis of Diabetes. Diabetes Care. 2015; 38(Supplement 1): S8–S16.
  13. Thygesen K, Alpert JS, White HD. W imieniu Wspólnej Komisji Specjalnej ESC/ACCF/AHA/WHF ds. nowelizacji definicji zawału serca. Uniwersalna definicja zawalu serca. Kardiol Pol. 2008; 66: 47–62.
  14. Jauch EC, Saver JL, Adams HP, et al. American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013; 44(3): 870–947.
  15. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002; 39(2 Suppl 1): S1–S266.
  16. Rosendaal FR, Cannegieter SC, van der Meer FJ, et al. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost. 1993; 69(3): 236–239.
  17. Dallalzadeh LO, Go AS, Chang Y, et al. Stability of high-quality warfarin anticoagulation in a community-based atrial fibrillation cohort: The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. J Am Heart Assoc. 2016; 5(7).
  18. Roldán V, Cancio S, Gálvez J, et al. The SAMe-TT2R2 score predicts poor anticoagulation control in AF patients: A prospective 'Real-world' Inception Cohort Study. Am J Med. 2015; 128(11): 1237–1243.
  19. Singer DE, Hellkamp AS, Piccini JP, et al. ROCKET AF Investigators. Impact of global geographic region on time in therapeutic range on warfarin anticoagulant therapy: data from the ROCKET AF clinical trial. J Am Heart Assoc. 2013; 2(1): e000067.
  20. Qureshi H, Sharafkhaneh A, Hanania NA. Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications. Ther Adv Chronic Dis. 2014; 5(5): 212–227.
  21. Hazlewood KA, Fugate SE, Harrison DL. Effect of oral corticosteroids on chronic warfarin therapy. Ann Pharmacother. 2006; 40(12): 2101–2106.
  22. Soliman EZ, Safford MM, Muntner P, et al. Atrial fibrillation and the risk of myocardial infarction. JAMA Intern Med. 2014; 174(1): 107–114.
  23. Zielonka A, Tkaczyszyn M, Mende M, et al. Atrial fibrillation in outpatients with stable coronary artery disease: results from the multicenter RECENT study. Pol Arch Med Wewn. 2015; 125(3): 162–171.
  24. Pastori D, Pignatelli P, Saliola M, et al. Inadequate anticoagulation by vitamin K antagonists is associated with major adverse cardiovascular events in patients with atrial fibrillation. Int J Cardiol. 2015; 201: 513–516.
  25. van Rein N, Cannegieter SC, le Cessie S, et al. Statins and risk of bleeding: an analysis to evaluate possible bias due to prevalent users and healthy user aspects. Am J Epidemiol. 2016; 183(10): 930–936.
  26. Undas A, Brummel-Ziedins KE, Mann KG. Anticoagulant effects of statins and their clinical implications. Thromb Haemost. 2014; 111(3): 392–400.
  27. Undas A, Brummel-Ziedins KE, Mann KG. Statins and blood coagulation. Arterioscler Thromb Vascu Biol. 2005; 25(2): 287–294.
  28. van Kuilenburg J, Lappegård KT, Sexton J, et al. Persisting thrombin activity in elderly patients with atrial fibrillation on oral anticoagulation is decreased by anti-inflammatory therapy with intensive cholesterol-lowering treatment. J Clin Lipidol. 2011; 5(4): 273–280.
  29. Andersson ML, Eliasson E, Lindh JD. A clinically significant interaction between warfarin and simvastatin is unique to carriers of the CYP2C9*3 allele. Pharmacogenomics. 2012; 13(7): 757–762.
  30. Cocco G, Jerie P. New concepts in the therapy of atrial fibrillation. Cardiol J. 2016; 23(1): 3–11.
  31. Turk UO, Tuncer E, Alioglu E, et al. Evaluation of the impact of warfarin time in therapeutic range on outcomes of patients with atrial fibrillation in Turkey: perspectives from the observational, prospective WATER Registry. Cardiol J. 2015; 22(5): 567–575.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl