Anticoagulation Control in Sweden: Reports of Time in Therapeutic Range, Major Bleeding, and Thrombo-Embolic Complications From the National Quality Registry AuriculA

May 31, 2011
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Authors:
Wieloch M, Själander A, Frykman V, Rosenqvist M, Eriksson N, Svensson PJ.
Citation:
Eur Heart J 2011;May 26:[Epub ahead of print].
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What are the patient characteristics, time in therapeutic range (TTR), bleeding, and thromboembolic complications in the Swedish national quality registry for atrial fibrillation and anticoagulation?

Methods:

AuriculA is a Swedish national quality registry of patients with atrial fibrillation. Prothrombin complex (international normalized ratio) values from 18,391 patients in 67 different centers were analyzed. TTR was calculated according to F.R. Roosendaal’s algorithm with linear interpolation.

Results:

The mean (SD) age was 70 (12) years. The main indications for warfarin treatment were: atrial fibrillation (64%), venous thromboembolism (19%), and heart valve dysfunction (13%). Time in therapeutic range for all patients was 76.2%. The mean weekly dose of warfarin decreased with age, and TTR increased with age. In 4,273 patients from two centers in AuriculA, the frequency of major bleeding and venous/arterial thromboembolism were 2.6 and 1.7%, and for atrial fibrillation, 2.6 and 1.4% per treatment year, respectively. A correlation between age and the risk of major bleeding (p < 0.001), but not thromboembolic complications (p = 0.147), was seen.

Conclusions:

The authors concluded that compared with prospective randomized trials of warfarin treatment, TTR in the AuriculA population was higher.

Perspective:

The study reports that compared with prospective randomized trials of warfarin treatment, TTR in the study population was higher. Complications were low, probably due to the organization of anticoagulation treatment in Sweden. Use of the AuriculA dosing program may also have contributed to the results by keeping dosing regimens consistent across all centers. Overall, the data confirm previous evidence that TTR is an excellent prognostic marker of the quality of anticoagulation treatment given in a clinical setting, and supports the need of an improved organization of specialized anticoagulation centers and treatment regimens in centers with consistently low levels of TTR.

Keywords: Blood Coagulation, Registries, Sweden, Warfarin, Venous Thromboembolism, Prothrombin, Heart Valves, Hemorrhage


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