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Type: Journal article
Title: Quality of warfarin anticoagulation in indigenous and non-indigenous Australians with atrial fibrillation
Author: Nguyen, M.T.
Gallagher, C.
Pitman, B.M.
Emami, M.
Kadhim, K.
Hendriks, J.M.
Middeldorp, M.E.
Roberts-Thomson, K.C.
Mahajan, R.
Lau, D.H.
Sanders, P.
Wong, C.X.
Citation: Heart, Lung and Circulation, 2019; 29(8):1122-1128
Publisher: Elsevier
Issue Date: 2019
ISSN: 1443-9506
Statement of
Mau T. Nguyen, Celine Gallagher, Bradley M. Pitman, Mehrdad Emami, Kadhim Kadhim, Jeroen M. Hendriks … et al.
Abstract: BACKGROUND: Studies have shown that suboptimal anticoagulation quality, as measured by time in therapeutic range (TTR), affects a significant percentage of patients with atrial fibrillation (AF). However, TTR has not been previously characterised in Indigenous Australians who experience a greater burden of AF and stroke. METHOD: Indigenous and non-Indigenous Australians with AF on warfarin anticoagulation therapy were identified from a large tertiary referral centre between 1999 and 2012. Time in therapeutic range was calculated as a proportion of daily international normalised ratio (INR) values between 2 and 3 for non-valvular AF and 2.5 to 3.5 for valvular AF. INR values between tests were imputed using the Rosendaal technique. Linear regression models were employed to characterise predictors of TTR. RESULTS: Five hundred and twelve (512) patients with AF on warfarin were included (88 Indigenous and 424 non-Indigenous). Despite younger age (51±13 vs 71±12 years, p<0.001), Indigenous Australians had greater valvular heart disease, diabetes, and alcohol excess compared to non-Indigenous Australians (p<0.05 for all). Time in therapeutic range was significantly lower in Indigenous compared to non-Indigenous Australians (40±29 vs 50±31%, p=0.006). Univariate predictors of poorer TTR included Indigenous ethnicity, younger age, diuretic use, and comorbidities, such as valvular heart disease, heart failure and chronic obstructive pulmonary disease (p<0.05 for all). Valvular heart disease remained a significant predictor of poorer TTR in multivariate analyses (p=0.004). CONCLUSION: Indigenous Australians experience particularly poor warfarin anticoagulation quality. Our data also suggest that many non-Indigenous Australians spend suboptimal time in therapeutic range. These findings reinforce the importance of monitoring warfarin anticoagulation quality to minimise stroke risk.
Keywords: Anticoagulation; Atrial fibrillation; Indigenous; Stroke; Warfarin
Rights: © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).Published by Elsevier B.V. All rights reserved.
RMID: 1000012932
DOI: 10.1016/j.hlc.2019.11.006
Appears in Collections:Medicine publications

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