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Comparison of the real-life clinical outcomes of warfarin with effective time in therapeutic range and NOACs: Insight from AFTER-2 Trial

Adem Aktan1, Tuncay Güzel2, Burhan Aslan2, Raif Kılıç3, Serhat Günlü4, Mehmet Özbek5, Bayram Arslan6, Muhammed Demir5, Faruk Ertaş5
DOI: 10.33963/KP.a2022.0287
·
Pubmed: 36594528
Affiliations
  1. Department of Cardiology, Mardin Training and Research Hospital, Mardin, Turkey
  2. Department of Cardiology, Health Science University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
  3. Department of Cardiology, Diyarlife Hospital, Diyarbakır, Turkey
  4. Department of Cardiology, Dağkapı State Hospital, Diyarbakır, Turkey
  5. Department of Cardiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
  6. Department of Cardiology, Ergani State Hospital, Diyarbakır, Turkey

open access

Online first
Original article
Published online: 2022-12-14

Abstract

BACKGROUND: We aimed to compare the long-term follow-up results of patients with atrial fibrillation (AF) who use vitamin K antagonist (VKA) with effective time in therapeutic range (TTR) and non-vitamin K antagonist oral anticoagulants (NOACs).

METHODS: A total of 1140 patients were followed at 35 different centers for five years. During the follow-up period, the INR values were studied at least 4 times a year and the TTR values were calculated according to the Roosendaal method. The effective TTR level was accepted as >60% as recommended by the guidelines. There were 254 patients in the effective TTR group and 886 patients in the NOACs group. Ischemic cerebrovascular disease/ transient ischemic attack (CVD/TIA), hemorrhagic CVD, and mortality were considered primary endpoints based on one-year and five-year follow-ups.

RESULTS: Ischemic CVD/TIA (3.9% vs. 6.2%; P = 0.17) and hemorrhagic CVD (0.4% vs. 0.5%, P = 0.69), the one-year mortality rate (7.1% vs. 8.1%; P = 0.59), five-year mortality rates (24% vs. 26.3%; P = 0.46) were not different between the effective TTR and NOACs groups during the follow-up respectively. The CHA2DS2-VASC score was similar between warfarin with the effective TTR group and NOACs group (3 [2–4] vs. 3 [2–4]; P = 0.17, respectively]. Additionally, survival free-time did not differ between the warfarin with effective TTR group and each NOAC in the Kaplan-Meier analysis (dabigatran, P = 0.59; rivaroxaban, P = 0.34; apixaban, P = 0.26; and edoxaban, P = 0.14).

CONCLUSION: There was no significant difference in primary outcomes between the effective TTR and NOAC groups in AF patients.

Abstract

BACKGROUND: We aimed to compare the long-term follow-up results of patients with atrial fibrillation (AF) who use vitamin K antagonist (VKA) with effective time in therapeutic range (TTR) and non-vitamin K antagonist oral anticoagulants (NOACs).

METHODS: A total of 1140 patients were followed at 35 different centers for five years. During the follow-up period, the INR values were studied at least 4 times a year and the TTR values were calculated according to the Roosendaal method. The effective TTR level was accepted as >60% as recommended by the guidelines. There were 254 patients in the effective TTR group and 886 patients in the NOACs group. Ischemic cerebrovascular disease/ transient ischemic attack (CVD/TIA), hemorrhagic CVD, and mortality were considered primary endpoints based on one-year and five-year follow-ups.

RESULTS: Ischemic CVD/TIA (3.9% vs. 6.2%; P = 0.17) and hemorrhagic CVD (0.4% vs. 0.5%, P = 0.69), the one-year mortality rate (7.1% vs. 8.1%; P = 0.59), five-year mortality rates (24% vs. 26.3%; P = 0.46) were not different between the effective TTR and NOACs groups during the follow-up respectively. The CHA2DS2-VASC score was similar between warfarin with the effective TTR group and NOACs group (3 [2–4] vs. 3 [2–4]; P = 0.17, respectively]. Additionally, survival free-time did not differ between the warfarin with effective TTR group and each NOAC in the Kaplan-Meier analysis (dabigatran, P = 0.59; rivaroxaban, P = 0.34; apixaban, P = 0.26; and edoxaban, P = 0.14).

CONCLUSION: There was no significant difference in primary outcomes between the effective TTR and NOAC groups in AF patients.

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Keywords

anticoagulants, atrial fibrillation, International Normalized Ratios, warfarin

About this article
Title

Comparison of the real-life clinical outcomes of warfarin with effective time in therapeutic range and NOACs: Insight from AFTER-2 Trial

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-12-14

Page views

140

Article views/downloads

69

DOI

10.33963/KP.a2022.0287

Pubmed

36594528

Keywords

anticoagulants
atrial fibrillation
International Normalized Ratios
warfarin

Authors

Adem Aktan
Tuncay Güzel
Burhan Aslan
Raif Kılıç
Serhat Günlü
Mehmet Özbek
Bayram Arslan
Muhammed Demir
Faruk Ertaş

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