Prothrombin Time-International Normalized Ratio Predicts the Outcome of Atrial Fibrillation Patients Taking Rivaroxaban
Background: Although direct oral anticoagulants (DOACs) for patients with atrial fibrillation (AF) are considered to be safe, over or under anticoagulation and increased bleeding or thromboembolic risk are still considered individually. We aimed to investigate whether there is an association between...
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MDPI AG
2022-12-01
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| Online Access: | https://www.mdpi.com/2227-9059/10/12/3210 |
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| author | Tze-Fan Chao Yi-Hsin Chan Pei-Chien Tsai Hsin-Fu Lee Shang-Hung Chang Chi-Tai Kuo Gregory Y. H. Lip Shih-Ann Chen Yung-Hsin Yeh |
| author_facet | Tze-Fan Chao Yi-Hsin Chan Pei-Chien Tsai Hsin-Fu Lee Shang-Hung Chang Chi-Tai Kuo Gregory Y. H. Lip Shih-Ann Chen Yung-Hsin Yeh |
| author_sort | Tze-Fan Chao |
| collection | DOAJ |
| description | Background: Although direct oral anticoagulants (DOACs) for patients with atrial fibrillation (AF) are considered to be safe, over or under anticoagulation and increased bleeding or thromboembolic risk are still considered individually. We aimed to investigate whether there is an association between prothrombin time and international normalized ratio (PT-INR) or activated partial thromboplastin time (aPTT) ratio, and the risks of ischemic stroke/systemic embolism (IS/SE) and major bleeding among AF patients taking rivaroxaban or dabigatran. Methods: This multi-center cohort study in Taiwan included 3192 AF patients taking rivaroxaban and 958 patients taking dabigatran for stroke prevention where data about PT-INR and aPTT were available. Results: For patients treated with rivaroxaban, a higher INR level was not associated with a higher risk of major bleeding compared to an INR level < 1.1. The risk of IS/SE was lower for patients having an INR ≥ 1.5 compared to those with an INR < 1.1 (aHR:0.57; [95%CI: 0.37–0.87]; <i>p</i> = 0.01). On-label dosing of rivaroxaban and use of digoxin were independent factors associated with an INR ≥ 1.5 after taking rivaroxaban. For patients taking dabigatran, a higher aPTT ratio was not associated with a higher risk of major bleeding. The risk of IS/SE was lower for patients having an aPTT ratio of 1.1–1.2 and 1.3–1.4 than those with an aPTT ratio < 1.1. Conclusions: In AF patients, rivaroxaban with an INR ≥ 1.5 was associated with a lower risk of IS/SE. PT-INR or aPTT ratios were not associated with bleeding events for rivaroxaban or dabigatran. INR may help predict the outcome of AF patients who take rivaroxaban. |
| first_indexed | 2024-03-09T17:18:28Z |
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| institution | Directory Open Access Journal |
| issn | 2227-9059 |
| language | English |
| last_indexed | 2024-03-09T17:18:28Z |
| publishDate | 2022-12-01 |
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| spelling | doaj.art-a447a945590d443bbb223ffd02eeb4f72023-11-24T13:28:45ZengMDPI AGBiomedicines2227-90592022-12-011012321010.3390/biomedicines10123210Prothrombin Time-International Normalized Ratio Predicts the Outcome of Atrial Fibrillation Patients Taking RivaroxabanTze-Fan Chao0Yi-Hsin Chan1Pei-Chien Tsai2Hsin-Fu Lee3Shang-Hung Chang4Chi-Tai Kuo5Gregory Y. H. Lip6Shih-Ann Chen7Yung-Hsin Yeh8Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, TaiwanThe Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan 33305, TaiwanDepartment and Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan 33302, TaiwanThe Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan 33305, TaiwanThe Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan 33305, TaiwanThe Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan 33305, TaiwanLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UKDivision of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, TaiwanThe Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan 33305, TaiwanBackground: Although direct oral anticoagulants (DOACs) for patients with atrial fibrillation (AF) are considered to be safe, over or under anticoagulation and increased bleeding or thromboembolic risk are still considered individually. We aimed to investigate whether there is an association between prothrombin time and international normalized ratio (PT-INR) or activated partial thromboplastin time (aPTT) ratio, and the risks of ischemic stroke/systemic embolism (IS/SE) and major bleeding among AF patients taking rivaroxaban or dabigatran. Methods: This multi-center cohort study in Taiwan included 3192 AF patients taking rivaroxaban and 958 patients taking dabigatran for stroke prevention where data about PT-INR and aPTT were available. Results: For patients treated with rivaroxaban, a higher INR level was not associated with a higher risk of major bleeding compared to an INR level < 1.1. The risk of IS/SE was lower for patients having an INR ≥ 1.5 compared to those with an INR < 1.1 (aHR:0.57; [95%CI: 0.37–0.87]; <i>p</i> = 0.01). On-label dosing of rivaroxaban and use of digoxin were independent factors associated with an INR ≥ 1.5 after taking rivaroxaban. For patients taking dabigatran, a higher aPTT ratio was not associated with a higher risk of major bleeding. The risk of IS/SE was lower for patients having an aPTT ratio of 1.1–1.2 and 1.3–1.4 than those with an aPTT ratio < 1.1. Conclusions: In AF patients, rivaroxaban with an INR ≥ 1.5 was associated with a lower risk of IS/SE. PT-INR or aPTT ratios were not associated with bleeding events for rivaroxaban or dabigatran. INR may help predict the outcome of AF patients who take rivaroxaban.https://www.mdpi.com/2227-9059/10/12/3210atrial fibrillationDOACsprothrombin timeactivated partial thromboplastin timeischemic strokemajor bleeding |
| spellingShingle | Tze-Fan Chao Yi-Hsin Chan Pei-Chien Tsai Hsin-Fu Lee Shang-Hung Chang Chi-Tai Kuo Gregory Y. H. Lip Shih-Ann Chen Yung-Hsin Yeh Prothrombin Time-International Normalized Ratio Predicts the Outcome of Atrial Fibrillation Patients Taking Rivaroxaban Biomedicines atrial fibrillation DOACs prothrombin time activated partial thromboplastin time ischemic stroke major bleeding |
| title | Prothrombin Time-International Normalized Ratio Predicts the Outcome of Atrial Fibrillation Patients Taking Rivaroxaban |
| title_full | Prothrombin Time-International Normalized Ratio Predicts the Outcome of Atrial Fibrillation Patients Taking Rivaroxaban |
| title_fullStr | Prothrombin Time-International Normalized Ratio Predicts the Outcome of Atrial Fibrillation Patients Taking Rivaroxaban |
| title_full_unstemmed | Prothrombin Time-International Normalized Ratio Predicts the Outcome of Atrial Fibrillation Patients Taking Rivaroxaban |
| title_short | Prothrombin Time-International Normalized Ratio Predicts the Outcome of Atrial Fibrillation Patients Taking Rivaroxaban |
| title_sort | prothrombin time international normalized ratio predicts the outcome of atrial fibrillation patients taking rivaroxaban |
| topic | atrial fibrillation DOACs prothrombin time activated partial thromboplastin time ischemic stroke major bleeding |
| url | https://www.mdpi.com/2227-9059/10/12/3210 |
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