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The changing characteristics of atrial fibrillation patients treated with warfarin

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Abstract

It has been suggested that direct oral anticoagulants are being preferentially used in low risk atrial fibrillation (AF) patients. Understanding the changing risk profile of new AF patients treated with warfarin is important for interpreting the quality of warfarin delivery through an anticoagulation clinic. Six anticoagulation clinics participating in the Michigan Anticoagulation Quality Improvement Initiative enrolled 1293 AF patients between 2010 and 2014 as an inception cohort. Abstracted data included demographics, comorbidities, medication use and all INR values. Risk scores including CHADS2, CHA2DS2-VASc, HAS-BLED, SAMe-TT2R2, and Charlson comorbidity index (CCI) were calculated for each patient at the time of warfarin initiation. The quality of anticoagulation was assessed using the Rosendaal time in the therapeutic range (TTR) during the first 6 months of treatment. Between 2010 and 2014, patients initiating warfarin therapy for AF had an increasing mean CHADS2 (2.0 ± 1.1 to 2.2 ± 1.4, p = 0.02) and CCI (4.7 ± 1.8 to 5.1 ± 2.0, p = 0.03), and a trend towards increasing mean CHA2DS2-VASc, HAS-BLED, and SAMe-TT2R2 scores. The actual TTR remained unchanged over the study period (62.6 ± 18.2 to 62.7 ± 17.0, p = 0.98), and the number of INR checks did not change (18.9 ± 5.2 to 18.5 ± 5.1, p = 0.06). Between 2010 and 2014, AF patients newly starting warfarin had mild increases in risk for stroke and death with sustained quality of warfarin therapy.

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Acknowledgments

MAQI2 is funded by Blue Cross Blue Shield of Michigan/Blue Care Network. However, the funding agency had no role in the collection or analysis of the data and no role in the creation or revisions of this manuscript. Dr. Barnes is supported by the National Heart, Lung and Blood Institute (2-T32-HL007853-16).

Disclosures

AP, XG, BH, JK, GK—none; EKR—consultant: Janssen, ACP, board member: AC Forum; SA—consulting fees/honoraria: Kona, Trice Orthopedics, Micardia; ownership/partnership/principal: Biostar Ventures, Ablative Solutions, research/research grants: Boston Scientific Watchman, Abbott Absorb trial; SK—consultant: BI, Janssen Dalichi Sankyo, Bristol Myer Squibb, Pfizer, speaker’s bureau: Janssen, Boehringer-Ingelheim, Bristol Myer Squibb, Pfizer, CSL Behring; JF—consultant Merck, Bristol Myer Squibb, Pfizer, Sanofi-Aventis, Janssen Pharmaceuticals; research grants: Fibromuscular Disease Society of America, Blue Cross/Blue Shield of Michigan; GB—consulting for Portolal research grants from Blue Cross/Blue Shield of Michigan and BMS/Pfizer.

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Authors and Affiliations

  1. University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr., Lobby A Rm 3201, Ann Arbor, MI, 48106, USA

    Andrew Putnam, Xiaokui Gu, Brian Haymart, Eva Kline-Rogers, James B. Froehlich & Geoffrey D. Barnes

  2. William Beaumont Hospital, 4600 Investment Dr., Suite 200, Troy, MI, 48098, USA

    Steve Almany

  3. Huron Valley Sinai Hospital, 1 William Carls Dr., Commerce, MI, 48382, USA

    Jay Kozlowski

  4. Henry Ford Health System, 2799 W. Grand Blvd., Detroit, MI, 48202, USA

    Gregory D. Krol

  5. Hurley Medical Center, 1 Hurley Plaza, Flint, MI, 48503, USA

    Scott Kaatz

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  1. Andrew Putnam
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  2. Xiaokui Gu
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  3. Brian Haymart
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  4. Eva Kline-Rogers
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  9. James B. Froehlich
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  10. Geoffrey D. Barnes
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Correspondence to Andrew Putnam.

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Putnam, A., Gu, X., Haymart, B. et al. The changing characteristics of atrial fibrillation patients treated with warfarin. J Thromb Thrombolysis 40, 488–493 (2015). https://doi.org/10.1007/s11239-015-1244-0

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  • DOI: https://doi.org/10.1007/s11239-015-1244-0

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