Publication

An easy-to-use tool to flag patients at risk of poor INR control: A streak of subtherapeutic INRs

van Miert, J. H. A., Veeger, N. J. G. M. & Meijer, K., Sep-2019, In : Thrombosis Research. 181, p. 46-51 6 p.

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  • An easy-to-use tool to flag patients at risk of poor INR control

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DOI

Introduction: Vitamin K antagonist therapy is safest and most effective with a high time within the therapeutic range (TTR). The TTR is difficult to calculate in the consultation room, therefore physicians need an easier-to-use tool to predict poor VKA control.

We explored the prognostic value of subtherapeutic INRs on future TTR in two settings:

(1) Clinical review setting, where a physician (bi) annually reviews a patient and uses the INRs since the last visit to predict the TTR up to the next visit;

(2) Day-to-day INR management setting, where every new INR measurement prompts a new prediction over the next 90 days.

Materials and methods: Retrospective cohort of 17,711 patients from a dedicated thrombosis service, using acenocoumarol (target range 2.0-3.0), with a "streak" defined as four consecutive INRs

(1) Odds ratios of any streak in the last 180 days or 1 year on a TTR <45% over the same period in the future;

(2) Odds ratio of a current streak on a TTR <45% over the next 90 days.

Results and conclusions: Clinical review setting: The occurrence of any streak in the last 180 days or 1 year increased the odds of a TTR <45%: ORs 2.84 (95% CI 2.41-3.34) and 3.25 (95% CI 2.72-3.87), respectively.

Day-to-day INR management setting: A current streak increases the odds of poor TTR over the next 90 days 3.58 (95% CI 2.64-4.87) fold.

We conclude that a streak of four consecutive subtherapeutic INRs can aid physicians in flagging at-risk patients.

Original languageEnglish
Pages (from-to)46-51
Number of pages6
JournalThrombosis Research
Volume181
Publication statusPublished - Sep-2019

    Keywords

  • Anticoagulants, Acenocoumarol, Coumarins, Decision support techniques, Quality control, ANTICOAGULATION, OUTCOMES, QUALITY

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