Anticoagulation control in Sweden: reports of time in therapeutic range, major bleeding, and thrombo-embolic complications from the national quality registry AuriculA

• Published in: European heart journal 2011-09, Vol.32 (18), p.2282-2289
• Main Authors: Wieloch, Mattias, Själander, Anders, Frykman, Viveka, Rosenqvist, Mårten, Eriksson, Niclas, Svensson, Peter J.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Atrial fibrillation; Atrial Fibrillation - blood; Atrial Fibrillation - drug therapy; Biological and medical sciences; Cardiac and Cardiovascular Systems; Cardiac dysrhythmias; Cardiology. Vascular system; Clinical Medicine; Heart; Heart Valve Diseases - blood; Heart Valve Diseases - drug therapy; Hemorrhage - chemically induced; Humans; INR; International Normalized Ratio; Kardiologi; Klinisk medicin; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Oral anticoagulation; Prospective Studies; Registries; Sweden; Thromboembolism - chemically induced; Thrombosis; TTR; Venous Thrombosis - blood; Venous Thrombosis - drug therapy; Warfarin; Warfarin - administration & dosage; Warfarin - adverse effects
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehr134

Aims In anticoagulation treatment with warfarin, the risk of thrombo-embolic events must be weighed against the risk of bleeding. Time in therapeutic range (TTR) is an important tool to assess the quality of anticoagulation treatment, and has been shown to correlate with less bleeding and thrombo-embolic complications. AuriculA, the Swedish national quality registry for atrial fibrillation and anticoagulation, is used for follow-up and dosage control of warfarin. This is the first report of TTR in AuriculA and, in a subgroup of two centres, bleeding and thrombo-embolic complications during 2008. Methods and results Prothrombin complex (International normalized ratio) values from 18 391 patients in 67 different centres were analysed. 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 4273 patients from two centres in AuriculA, the frequency of major bleedings and venous/arterial thrombo-embolism 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 thrombo-embolic complications (P= 0.147), was seen. Conclusion Compared with prospective randomized trials of warfarin treatment, TTR in the AuriculA population was higher. Complications were low, probably due to the organization of anticoagulation treatment in Sweden. Use of the AuriculA dosing programme could have contributed to the results by keeping dosing regimens consistent over all centres.