Volumen: 20 # Number : 1
Publication Date : Enero - Abril Year: 2016
Assessment in Argentina of the Time in Therapeutic Range
in Atrial Fibrillation patients anticoagulated with
vitamin K antagonists. The TERRA registry.
Authors: Tajer CD, Ceresetto JM, Bottaro F, Martí A, Casey M
Abstract: Assessment of the time in therapeutic range in patients
with atrial fibrillation treated with vitamin
K antagonists by specialists in Haemostasis in
Argentina. The TERRA registry.
Vitamin K antagonists (VKA) should be monitored
by the time in therapeutic range (TTR) which evaluates
the percent of time that a patient remains in
the targeted INR. In non valvular atrial fibrillation
(NVAF) a low TTR (<60%) has been associated
with increasing risk of stroke, bleeding and death.
Although some Latin America registries showed a
low TTR (44%) in the region, there is no data available
about the quality of anticoagulation in our country.
Objective: To assess the TTR in a multicenter
network of patients with NVAF treated with VKA in
Argentina. The TERRA trial is a multicenter, observational
study involving 14 anticoagulation clinics. Both private and public institutions recruited prospectively
the first 100 consecutive patients with
NVAF treated with VKA for at least one year. The
INR was retrieved from controls and TTR calculated
(Rosendaal method). The first 3 months of treatment
with VKA were excluded from the analysis. Results:
1190 patients were included in the analysis. Mean
age was 75 ± 9.9 years, 52% were male. Mean TTR
was 66.6 ± 19.4% (median 67.5%, IQI 54-80). Inter
institution variability was marked, range 58 ± 17%
to 88 ± 17%, p<0.001. In all, 34% of the patients
had a TTR <60% and 20% a TTR <50%. Age >80
years, female sex and use of acenocumarol did not
correlate with a low TTR. If the targeted INR would
have been between 1.9 and 3.1, median TTR would
have been 74.5%. Conclusions: 1) Mean TTR in patients
with AF treated with VKA in this multicenter network of Argentinean Haemostasis specialists
was high and similar to some recent international
therapeutic clinical trials (55-65%), indicating that
high-quality anticoagulation with VKAs is possible
in Latin America. 2) Even with this level of excellence one third of patients exhibited a TTR below
60% and might be candidates for an alternative
management. 3) The addition of TTR to clinical
practice may help to improve the results of oral anticoagulation
in patients with AF.
Key words: Time in therapeutic range,
Quality of anticoagulation,
Registry in Argentina
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