An easy-to-use tool to flag patients at risk of poor INR control: a streak of subtherapeutic INRs
ISTH Academy. van Miert J. 07/09/19; 264851; PB1664 Topic: VTE Therapy
Jasper H.A. van Miert
Jasper H.A. van Miert
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PB1664

An Easy-to-Use Tool to Flag Patients at Risk of Poor INR Control: A Streak of Subtherapeutic INRs

J.H.A. van Miert1,2, N.J.G.M. Veeger3, K. Meijer1
1University of Groningen, University Medical Centre Groningen, Haematology, Groningen, the Netherlands, 2Certe Thrombosis Service, Groningen, the Netherlands, 3University of Groningen, University Medical Centre Groningen, Epidemiology, Groningen, the Netherlands

Main Topic: Venous Thromboembolism
Category: VTE Therapy

Background: Vitamin K antagonist therapy is safest and most effective with a high time within the therapeutic range (TTR). The TTR is difficult to calculate in the consultation room, therefore physicians need an easier-to-use tool to predict poor VKA control.
Aims: To explore the prognostic value of subtherapeutic INRs on future TTR in two settings:
(1) Clinical review setting, where a physician (bi)annually reviews a patient and uses the INRs since the last visit to predict the TTR up to the next visit;
(2) Day-to-day INR management setting, where every new INR measurement prompts a new prediction over the next 90 days.
Methods: Retrospective cohort of 17,468 patients from a dedicated thrombosis service, using acenocoumarol (target range 2.0-3.0), with a 'streak' defined as four consecutive INRs < 2.0.
(1) Odds ratios of any streak in the last 180 days or 1 year on a TTR < 45% over the same period in the future;
(2) Odds ratio of a current streak on a TTR < 45% over the next 90 days.
Results: In the clinical review setting, the occurrence of any streak in the last 180 days or 1 year increased the odds of a TTR < 45%: ORs 2.93 (95% CI 2.49-3.44) and 3.20 (95% CI 2.68-3.81), respectively.
If the most recent INR and the three previous INRs were all subtherapeutic, the odds of poor TTR over the next 90 days increased 3.15 (95% CI 1.99-4.97) fold.
Conclusions: A streak of four consecutive subtherapeutic INRs can aid physicians in flagging at-risk patients.

PB1664

An Easy-to-Use Tool to Flag Patients at Risk of Poor INR Control: A Streak of Subtherapeutic INRs

J.H.A. van Miert1,2, N.J.G.M. Veeger3, K. Meijer1
1University of Groningen, University Medical Centre Groningen, Haematology, Groningen, the Netherlands, 2Certe Thrombosis Service, Groningen, the Netherlands, 3University of Groningen, University Medical Centre Groningen, Epidemiology, Groningen, the Netherlands

Main Topic: Venous Thromboembolism
Category: VTE Therapy

Background: Vitamin K antagonist therapy is safest and most effective with a high time within the therapeutic range (TTR). The TTR is difficult to calculate in the consultation room, therefore physicians need an easier-to-use tool to predict poor VKA control.
Aims: To explore the prognostic value of subtherapeutic INRs on future TTR in two settings:
(1) Clinical review setting, where a physician (bi)annually reviews a patient and uses the INRs since the last visit to predict the TTR up to the next visit;
(2) Day-to-day INR management setting, where every new INR measurement prompts a new prediction over the next 90 days.
Methods: Retrospective cohort of 17,468 patients from a dedicated thrombosis service, using acenocoumarol (target range 2.0-3.0), with a 'streak' defined as four consecutive INRs < 2.0.
(1) Odds ratios of any streak in the last 180 days or 1 year on a TTR < 45% over the same period in the future;
(2) Odds ratio of a current streak on a TTR < 45% over the next 90 days.
Results: In the clinical review setting, the occurrence of any streak in the last 180 days or 1 year increased the odds of a TTR < 45%: ORs 2.93 (95% CI 2.49-3.44) and 3.20 (95% CI 2.68-3.81), respectively.
If the most recent INR and the three previous INRs were all subtherapeutic, the odds of poor TTR over the next 90 days increased 3.15 (95% CI 1.99-4.97) fold.
Conclusions: A streak of four consecutive subtherapeutic INRs can aid physicians in flagging at-risk patients.

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