Optimal INR Level in Patients Receiving the Triple Therapy
Keywords:
Dual antiplatelets, Triple therapy, Warfarin, Stroke, Bleeding, Atrial fibrillarionAbstract
Background: There are many patients receiving both dual antiplatelets and warfarin who are at risk of bleeding complication. However, no study on the optimal INR level in patients receiving triple therapy has been reported.
Objectives: To identify optimal INR level in Thai patients receiving triple therapy that caused the lowest thromboembolic and bleeding events.
Methods: Triple therapy patients were retrospectively enrolled since 1st January 2002 to 31st March 2013. The INR range were divided into 5 groups (less than 1.5, 1.5 to 2.0, 2.1 to 2.5, 2.6 to 3.0 and more than 3.0). Thromboembolicand bleeding events in each group were collected. The optimal INR level was the level that patients had the least thromboembolic and bleeding events. Results: A total of 235 patients (the mean age 61.3±10.9 years) were eligible, contributing to 122.35 patient-years of observational period. The patient-time spent within therapeutic INR range (2-3), less than 2 and more than 3 was 28.2%, 76.3%, 5.5%, respectively. Of 235 patients, one patient experienced one ischemic stroke (0.82 per 100 patient-years), 3 patients experienced 3 major life-threatening bleeding events (2.45 per 100 patient-years), one patient experienced one major non life-theatening bleeding event (0.82 per 100 patient-years), and 31 patients experienced 42 minor bleeding events (34.33 per 100 patient-years). Each group of INR level was not statistically significant in thromboembolic event. Total bleeding events was found to be significantly increased in INR level more than 1.5 (p < 0.001, 95%CI CI = 2.35-44.01, RR = 8.22).
Conclusions: The INR level less than 1.5 had the least total bleeding events and comparable ischemic stroke compared with the INR level more than 1.5 in patients with triple therapy. Further larger prospective study should be conducted to confirm these results in the future.
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