• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (86)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in this journal  Topic Collections  • Thrombolysis  • Neurology  • Stroke  • Treatment Adherence  • Cardiovascular System  • Randomized Controlled Trial  • Prognosis/ Outcomes  • Arrhythmias  • Cardiovascular Disease/ Myocardial Infarction  • Drug Therapy  • Adherence  • Alert me on articles by topic  Social Bookmarking   What's this?

Results From SPORTIF III and V

Harvey D. White, DSc; Michael Gruber, MSc; Jan Feyzi, MS; Scott Kaatz, DO; Hung-Fat Tse, MD; Steen Husted, MD; Gregory W. Albers, MD

Arch Intern Med. 2007;167(3):239-245.

Background  Warfarin sodium reduces stroke risk in patients with atrial fibrillation, but international normalized ratio (INR) monitoring is required. Target INRs are frequently not achieved, and the risk of death, bleeding, myocardial infarction (MI), and stroke or systemic embolism event (SEE) may be related to INR control.

Methods  We analyzed the relationship between INR control and the rates of death, bleeding, MI, and stroke or SEE among 3587 patients with atrial fibrillation randomized to receive warfarin treatment in the SPORTIF (Stroke Prevention Using an Oral Thrombin Inhibitor in Atrial Fibrillation) III and V trials. The mean±SD follow-up was 16.6 ± 6.3 months. Patients were divided into 3 equal groups (those with good control [>75%], those with moderate control [60%-75%], or those with poor control [<60%]) according to the percentage time with an INR of 2.0 to 3.0. Outcomes were compared according to INR control. The main outcome measures were death, bleeding, MI, and stroke or SEE.

Results  The poor control group had higher rates of annual mortality (4.20%) and major bleeding (3.85%) compared with the moderate control group (1.84% and 1.96%, respectively) and the good control group (1.69% and 1.58%, respectively) (P<.01 for all). Compared with the good control group, the poor control group had higher rates of MI (1.38% vs 0.62%, P = .04) and of stroke or SEE (2.10% vs 1.07%, P = .02).

Conclusions  In patients with atrial fibrillation taking warfarin, the risks of death, MI, major bleeding, and stroke or SEE are related to INR control. Good INR control is important to improve patient outcomes.

Author Affiliations: Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (Dr White); Department of Biostatistics, University of Wisconsin–Madison (Mr Gruber and Ms Feyzi); Department of Internal Medicine, Henry Ford Hospital, Detroit, Mich (Dr Kaatz); Cardiology Division, Department of Medicine, Queen Mary Hospital, Hong Kong (Dr Tse); Department of Medicine and Cardiology, Aarhus University Hospital, Aarhus, Denmark (Dr Husted); and Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, Calif (Dr Albers).

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLES

The Influence of Patient Adherence on Anticoagulation Control With Warfarin: Results From the International Normalized Ratio Adherence and Genetics (IN-RANGE) Study
Stephen E. Kimmel, Zhen Chen, Maureen Price, Catherine S. Parker, Joshua P. Metlay, Jason D. Christie, Colleen M. Brensinger, Craig W. Newcomb, Frederick F. Samaha, and Robert Gross
Arch Intern Med. 2007;167(3):229-235.
ABSTRACT | FULL TEXT  

Newly Detected Atrial Fibrillation and Compliance With Antithrombotic Guidelines
Nicole L. Glazer, Sascha Dublin, Nicholas L. Smith, Benjamin French, Lisa A. Jackson, Jennifer B. Hrachovec, David S. Siscovick, Bruce M. Psaty, and Susan R. Heckbert
Arch Intern Med. 2007;167(3):246-252.
ABSTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Oral Anticoagulant Therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
Ageno et al.
Chest 2012;141:e44S-e88S.
ABSTRACT | FULL TEXT  

Antithrombotic Therapy for Atrial Fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
You et al.
Chest 2012;141:e531S-e575S.
ABSTRACT | FULL TEXT  

Warfarin and acetaminophen interaction: a summary of the evidence and biologic plausibility
Lopes et al.
Blood 2011;118:6269-6273.
FULL TEXT  

Dabigatran: Will it change clinical practice?
WARTAK and BARTHOLOMEW
Cleveland Clinic Journal of Medicine 2011;78:657-664.
ABSTRACT | FULL TEXT  

Dabigatran etexilate: A novel oral direct thrombin inhibitor
Blommel and Blommel
Am J Health Syst Pharm 2011;68:1506-1519.
ABSTRACT | FULL TEXT  

Strategies to Improve Oral Anticoagulation Management
Smith et al.
Chest 2011;140:281-282.
FULL TEXT  

Reexamining the Recommended Follow-up Interval After Obtaining an In-Range International Normalized Ratio Value: Results from the Veterans Affairs Study to Improve Anticoagulation
Rose et al.
Chest 2011;140:359-365.
ABSTRACT | FULL TEXT  

The Business Case for Quality Improvement: Oral Anticoagulation for Atrial Fibrillation
Rose et al.
Circ Cardiovasc Qual Outcomes 2011;4:416-424.
ABSTRACT | FULL TEXT  

Intensity of Anticoagulation with Warfarin and Risk of Adverse Events in Patients Presenting to the Emergency Department
Anthony et al.
The Annals of Pharmacotherapy 2011;45:881-887.
ABSTRACT | FULL TEXT  

Quality of management of oral anticoagulation as assessed by time in therapeutic INR range in elderly and younger patients with low mean years of formal education: a prospective cohort study
Costa et al.
Age Ageing 2011;40:375-381.
ABSTRACT | FULL TEXT  

Prompt Repeat Testing After Out-of-Range INR Values: A Quality Indicator for Anticoagulation Care
Rose et al.
Circ Cardiovasc Qual Outcomes 2011;4:276-282.
ABSTRACT | FULL TEXT  

Bleeding risk assessment and management in atrial fibrillation patients: a position document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis
Lip et al.
Europace 2011;13:723-746.
ABSTRACT | FULL TEXT  

Meta-analysis: Effect of Patient Self-testing and Self-management of Long-Term Anticoagulation on Major Clinical Outcomes
Bloomfield et al.
ANN INTERN MED 2011;154:472-482.
ABSTRACT | FULL TEXT  

Clinical Outcomes of a Collaborative, Home-Based Postdischarge Warfarin Management Service
Stafford et al.
The Annals of Pharmacotherapy 2011;45:325-334.
ABSTRACT | FULL TEXT  

Risk-Adjusted Percent Time in Therapeutic Range as a Quality Indicator for Outpatient Oral Anticoagulation: Results of the Veterans Affairs Study To Improve Anticoagulation (VARIA)
Rose et al.
Circ Cardiovasc Qual Outcomes 2011;4:22-29.
ABSTRACT | FULL TEXT  

High blood pressure while taking antithrombotic medication is associated with an increased risk of developing intracranial haemorrhage
Rose and Hylek
Evid. Based Med. 2010;15:189-190.
FULL TEXT  

Stroke Risk and Antithrombotic Strategies in Atrial Fibrillation
Medi et al.
Stroke 2010;41:2705-2713.
ABSTRACT | FULL TEXT  

The Evolving Field of Stroke Prevention in Patients With Atrial Fibrillation
Ezekowitz et al.
Stroke 2010;41:S17-S20.
ABSTRACT | FULL TEXT  

Will direct thrombin inhibition change the boundaries of oral anti-coagulation?
Lomas et al.
QJM 2010;103:429-434.
FULL TEXT  

Dabigatran Challenges Warfarin's Superiority for Stroke Prevention in Atrial Fibrillation
Schwartz and Albers
Stroke 2010;41:1307-1309.
FULL TEXT  

Cognitive Function and Anticoagulation Control in Patients With Atrial Fibrillation
Flaker et al.
Circ Cardiovasc Qual Outcomes 2010;3:277-283.
ABSTRACT | FULL TEXT  

Medication Errors in Acute Cardiovascular and Stroke Patients: A Scientific Statement From the American Heart Association
Michaels et al.
Circulation 2010;121:1664-1682.
FULL TEXT  

The Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation
Bussey
ANN INTERN MED 2010;152:264-265.
FULL TEXT  

Epidemiology of Subtherapeutic Anticoagulation in the United States
Rose et al.
Circ Cardiovasc Qual Outcomes 2009;2:591-597.
ABSTRACT | FULL TEXT  

The First Evaluation of a Novel Vitamin K Antagonist, Tecarfarin (ATI-5923), in Patients With Atrial Fibrillation
Ellis et al.
Circulation 2009;120:1029-1035.
ABSTRACT | FULL TEXT  

How I treat the antiphospholipid syndrome
Giannakopoulos and Krilis
Blood 2009;114:2020-2030.
ABSTRACT | FULL TEXT  

Dabigatran Etexilate: Future Directions in Anticoagulant Treatment
Schulman and Reilly
CLIN APPL THROMB HEMOST 2009;15:32S-41S.
ABSTRACT  

Should Patient Characteristics Influence Target Anticoagulation Intensity for Stroke Prevention in Nonvalvular Atrial Fibrillation?: The ATRIA Study
Singer et al.
Circ Cardiovasc Qual Outcomes 2009;2:297-304.
ABSTRACT | FULL TEXT  

Effect of a Warfarin Adherence Aid on Anticoagulation Control in an Inner-City Anticoagulation Clinic Population
Nochowitz et al.
The Annals of Pharmacotherapy 2009;43:1165-1172.
ABSTRACT | FULL TEXT  

Benefit of Oral Anticoagulant Over Antiplatelet Therapy in Atrial Fibrillation Depends on the Quality of International Normalized Ratio Control Achieved by Centers and Countries as Measured by Time in Therapeutic Range
Connolly et al.
Circulation 2008;118:2029-2037.
ABSTRACT | FULL TEXT  

Disparate Stroke Rates on Warfarin Among Contemporaneous Cohorts With Atrial Fibrillation: Potential Insights Into Risk From a Comparative Analysis of SPORTIF III Versus SPORTIF V
Hylek et al.
Stroke 2008;39:3009-3014.
ABSTRACT | FULL TEXT  

Pharmacology and Management of the Vitamin K Antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Ansell et al.
Chest 2008;133:160S-198S.
ABSTRACT | FULL TEXT  

An update on cardioembolic stroke
Weir
Postgrad. Med. J. 2008;84:133-142.
ABSTRACT | FULL TEXT  

Warfarin Therapy in Clinical Practice
JWatch Neurology 2007;2007:2-2.
FULL TEXT  

Evidently...
Lehmann
Evid. Based Med. 2007;12:69-69.
FULL TEXT  

Other articles noted
Evid. Based Med. 2007;12:95-96.
FULL TEXT