Target international normalized ratio values for preventing thromboembolic and hemorrhagic events in Japanese patients with non-valvular atrial fibrillation

Results of the J-RHYTHM registry

Hiroshi Inoue, Ken Okumura, Hirotsugu Atarashi, Takeshi Yamashita, Hideki Origasa, Naoko Kumagai, Masayuki Sakurai, Yuichiro Kawamura, Isao Kubota, Kazuo Matsumoto, Yoshiaki Kaneko, Satoshi Ogawa, Yoshifusa Aizawa, Masaomi Chinushi, Itsuo Kodama, Eiichi Watanabe, Yukihiro Koretsune, Yuji Okuyama, Akihiko Shimizu, Osamu Igawa & 4 others Shigenobu Bando, Masahiko Fukatani, Tetsunori Saikawa, Akiko Chishaki

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Background: Target anticoagulation levels for warfarin in Japanese patients with non-valvular atrial fibrillation (NVAF) are unclear. Methods and Results: Of 7,406 patients with NVAF, 1,002 did not receive warfarin (non-warfarin group), and the remaining patients receiving warfarin were divided into 5 groups based on their baseline international normalized ratio (INR) of prothrombin time (≤1.59, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0). Patients were followed-up prospec-tively for 2 years. Primary endpoints were thromboembolic events (cerebral infarction, transient ischemic attack, and systemic embolism), and major hemorrhage requiring hospital admission. During the follow-up period, thromboem-bolic events occurred in 3.0% of non-warfarin group, but at lower frequencies in the warfarin groups (2.0, 1.3, 1.5, 0.6, and 1.8%/2 years for INR values of ≤1.59, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0, respectively; P=0.0059). Major hemorrhage occurred more frequently in warfarin groups (1.5, 1.8, 2.4, 3.3, and 4.1% for INR values ≤1.59, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0, respectively; P=0.0041) than in non-warfarin group (0.8%/2 years). These trends were maintained when the analyses were confined to patients aged ≥70 years. Conclusions: An INR of 1.6-2.6 is safe and effective at preventing thromboembolic events in patients with NVAF, particularly patients aged ≥70 years. An INR of 2.6-2.99 is also effective, but associated with a slightly increased risk in major hemorrhage.

Original languageEnglish
Pages (from-to)2264-2270
Number of pages7
JournalCirculation Journal
Volume77
Issue number9
DOIs
Publication statusPublished - 28-08-2013

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International Normalized Ratio
Atrial Fibrillation
Registries
Warfarin
Hemorrhage
Spectinomycin
Prothrombin Time
Transient Ischemic Attack
Cerebral Infarction
Embolism

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Inoue, Hiroshi ; Okumura, Ken ; Atarashi, Hirotsugu ; Yamashita, Takeshi ; Origasa, Hideki ; Kumagai, Naoko ; Sakurai, Masayuki ; Kawamura, Yuichiro ; Kubota, Isao ; Matsumoto, Kazuo ; Kaneko, Yoshiaki ; Ogawa, Satoshi ; Aizawa, Yoshifusa ; Chinushi, Masaomi ; Kodama, Itsuo ; Watanabe, Eiichi ; Koretsune, Yukihiro ; Okuyama, Yuji ; Shimizu, Akihiko ; Igawa, Osamu ; Bando, Shigenobu ; Fukatani, Masahiko ; Saikawa, Tetsunori ; Chishaki, Akiko. / Target international normalized ratio values for preventing thromboembolic and hemorrhagic events in Japanese patients with non-valvular atrial fibrillation : Results of the J-RHYTHM registry. In: Circulation Journal. 2013 ; Vol. 77, No. 9. pp. 2264-2270.
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abstract = "Background: Target anticoagulation levels for warfarin in Japanese patients with non-valvular atrial fibrillation (NVAF) are unclear. Methods and Results: Of 7,406 patients with NVAF, 1,002 did not receive warfarin (non-warfarin group), and the remaining patients receiving warfarin were divided into 5 groups based on their baseline international normalized ratio (INR) of prothrombin time (≤1.59, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0). Patients were followed-up prospec-tively for 2 years. Primary endpoints were thromboembolic events (cerebral infarction, transient ischemic attack, and systemic embolism), and major hemorrhage requiring hospital admission. During the follow-up period, thromboem-bolic events occurred in 3.0{\%} of non-warfarin group, but at lower frequencies in the warfarin groups (2.0, 1.3, 1.5, 0.6, and 1.8{\%}/2 years for INR values of ≤1.59, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0, respectively; P=0.0059). Major hemorrhage occurred more frequently in warfarin groups (1.5, 1.8, 2.4, 3.3, and 4.1{\%} for INR values ≤1.59, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0, respectively; P=0.0041) than in non-warfarin group (0.8{\%}/2 years). These trends were maintained when the analyses were confined to patients aged ≥70 years. Conclusions: An INR of 1.6-2.6 is safe and effective at preventing thromboembolic events in patients with NVAF, particularly patients aged ≥70 years. An INR of 2.6-2.99 is also effective, but associated with a slightly increased risk in major hemorrhage.",
author = "Hiroshi Inoue and Ken Okumura and Hirotsugu Atarashi and Takeshi Yamashita and Hideki Origasa and Naoko Kumagai and Masayuki Sakurai and Yuichiro Kawamura and Isao Kubota and Kazuo Matsumoto and Yoshiaki Kaneko and Satoshi Ogawa and Yoshifusa Aizawa and Masaomi Chinushi and Itsuo Kodama and Eiichi Watanabe and Yukihiro Koretsune and Yuji Okuyama and Akihiko Shimizu and Osamu Igawa and Shigenobu Bando and Masahiko Fukatani and Tetsunori Saikawa and Akiko Chishaki",
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Inoue, H, Okumura, K, Atarashi, H, Yamashita, T, Origasa, H, Kumagai, N, Sakurai, M, Kawamura, Y, Kubota, I, Matsumoto, K, Kaneko, Y, Ogawa, S, Aizawa, Y, Chinushi, M, Kodama, I, Watanabe, E, Koretsune, Y, Okuyama, Y, Shimizu, A, Igawa, O, Bando, S, Fukatani, M, Saikawa, T & Chishaki, A 2013, 'Target international normalized ratio values for preventing thromboembolic and hemorrhagic events in Japanese patients with non-valvular atrial fibrillation: Results of the J-RHYTHM registry', Circulation Journal, vol. 77, no. 9, pp. 2264-2270. https://doi.org/10.1253/circj.CJ-13-0290

Target international normalized ratio values for preventing thromboembolic and hemorrhagic events in Japanese patients with non-valvular atrial fibrillation : Results of the J-RHYTHM registry. / Inoue, Hiroshi; Okumura, Ken; Atarashi, Hirotsugu; Yamashita, Takeshi; Origasa, Hideki; Kumagai, Naoko; Sakurai, Masayuki; Kawamura, Yuichiro; Kubota, Isao; Matsumoto, Kazuo; Kaneko, Yoshiaki; Ogawa, Satoshi; Aizawa, Yoshifusa; Chinushi, Masaomi; Kodama, Itsuo; Watanabe, Eiichi; Koretsune, Yukihiro; Okuyama, Yuji; Shimizu, Akihiko; Igawa, Osamu; Bando, Shigenobu; Fukatani, Masahiko; Saikawa, Tetsunori; Chishaki, Akiko.

In: Circulation Journal, Vol. 77, No. 9, 28.08.2013, p. 2264-2270.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Target international normalized ratio values for preventing thromboembolic and hemorrhagic events in Japanese patients with non-valvular atrial fibrillation

T2 - Results of the J-RHYTHM registry

AU - Inoue, Hiroshi

AU - Okumura, Ken

AU - Atarashi, Hirotsugu

AU - Yamashita, Takeshi

AU - Origasa, Hideki

AU - Kumagai, Naoko

AU - Sakurai, Masayuki

AU - Kawamura, Yuichiro

AU - Kubota, Isao

AU - Matsumoto, Kazuo

AU - Kaneko, Yoshiaki

AU - Ogawa, Satoshi

AU - Aizawa, Yoshifusa

AU - Chinushi, Masaomi

AU - Kodama, Itsuo

AU - Watanabe, Eiichi

AU - Koretsune, Yukihiro

AU - Okuyama, Yuji

AU - Shimizu, Akihiko

AU - Igawa, Osamu

AU - Bando, Shigenobu

AU - Fukatani, Masahiko

AU - Saikawa, Tetsunori

AU - Chishaki, Akiko

PY - 2013/8/28

Y1 - 2013/8/28

N2 - Background: Target anticoagulation levels for warfarin in Japanese patients with non-valvular atrial fibrillation (NVAF) are unclear. Methods and Results: Of 7,406 patients with NVAF, 1,002 did not receive warfarin (non-warfarin group), and the remaining patients receiving warfarin were divided into 5 groups based on their baseline international normalized ratio (INR) of prothrombin time (≤1.59, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0). Patients were followed-up prospec-tively for 2 years. Primary endpoints were thromboembolic events (cerebral infarction, transient ischemic attack, and systemic embolism), and major hemorrhage requiring hospital admission. During the follow-up period, thromboem-bolic events occurred in 3.0% of non-warfarin group, but at lower frequencies in the warfarin groups (2.0, 1.3, 1.5, 0.6, and 1.8%/2 years for INR values of ≤1.59, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0, respectively; P=0.0059). Major hemorrhage occurred more frequently in warfarin groups (1.5, 1.8, 2.4, 3.3, and 4.1% for INR values ≤1.59, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0, respectively; P=0.0041) than in non-warfarin group (0.8%/2 years). These trends were maintained when the analyses were confined to patients aged ≥70 years. Conclusions: An INR of 1.6-2.6 is safe and effective at preventing thromboembolic events in patients with NVAF, particularly patients aged ≥70 years. An INR of 2.6-2.99 is also effective, but associated with a slightly increased risk in major hemorrhage.

AB - Background: Target anticoagulation levels for warfarin in Japanese patients with non-valvular atrial fibrillation (NVAF) are unclear. Methods and Results: Of 7,406 patients with NVAF, 1,002 did not receive warfarin (non-warfarin group), and the remaining patients receiving warfarin were divided into 5 groups based on their baseline international normalized ratio (INR) of prothrombin time (≤1.59, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0). Patients were followed-up prospec-tively for 2 years. Primary endpoints were thromboembolic events (cerebral infarction, transient ischemic attack, and systemic embolism), and major hemorrhage requiring hospital admission. During the follow-up period, thromboem-bolic events occurred in 3.0% of non-warfarin group, but at lower frequencies in the warfarin groups (2.0, 1.3, 1.5, 0.6, and 1.8%/2 years for INR values of ≤1.59, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0, respectively; P=0.0059). Major hemorrhage occurred more frequently in warfarin groups (1.5, 1.8, 2.4, 3.3, and 4.1% for INR values ≤1.59, 1.6-1.99, 2.0-2.59, 2.6-2.99, and ≥3.0, respectively; P=0.0041) than in non-warfarin group (0.8%/2 years). These trends were maintained when the analyses were confined to patients aged ≥70 years. Conclusions: An INR of 1.6-2.6 is safe and effective at preventing thromboembolic events in patients with NVAF, particularly patients aged ≥70 years. An INR of 2.6-2.99 is also effective, but associated with a slightly increased risk in major hemorrhage.

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DO - 10.1253/circj.CJ-13-0290

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JF - Circulation Journal

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