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Risk of major bleeding at different PT-INR ranges in elderly Japanese patients with non-valvular atrial fibrillation receiving warfarin: a nested case-control study

Overview of attention for article published in Journal of Pharmaceutical Health Care and Sciences, January 2016
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Title
Risk of major bleeding at different PT-INR ranges in elderly Japanese patients with non-valvular atrial fibrillation receiving warfarin: a nested case-control study
Published in
Journal of Pharmaceutical Health Care and Sciences, January 2016
DOI 10.1186/s40780-015-0036-1
Pubmed ID
Authors

Atsushi Ohgushi, Takayuki Ohtani, Natsumi Nakayama, Shigeo Asai, Yoshiyuki Ishii, Atsuo Namiki, Manabu Akazawa, Hirotoshi Echizen

Abstract

Debate continues about the optimal anticoagulation level for elderly Japanese patients with non-valvular atrial fibrillation (NVAF) receiving warfarin. The Japanese Circulation Society guideline has recommended prothrombin time-international normalized ratios (PT-INR) of 1.6 - 2.6 for elderly patients and 2.0 - 3.0 for non-elderly patients, because previous observational studies indicated increased risk of bleeding when the ratio exceeded 2.6. We aimed to reappraise the relationship between PT-INR and the risk of major bleeding in elderly Japanese patients. From the electronic medical records, we selected a cohort of elderly (age ≥ 70 years) Japanese patients with NVAF who were prescribed warfarin for the prevention of thromboembolic diseases between November 2010 and March 2014 at Kanto Rosai Hospital. We identified those who developed major bleeding (cases). For each case, we randomly selected two matched controls by adopting a risk-set sampling method defined by calendar date, age, gender, length of warfarin administration, and the prescriber of warfarin. The risk of major bleeding in patients having PT-INR ≤ 1.49, 1.50 - 1.99, 2.00 - 2.49 (the reference), 2.50 - 2.99, and ≥ 3.00 were compared using the conditional logistic regression method. The study protocol was approved by the IRB before the study was begun. Among the cohort of 806 elderly patients, we identified 32 cases and selected 64 matched controls. The overall incidence of major bleeding was 3.5 per 100 patient-years. The odds ratios (95 % confidence intervals) for the risk of developing major bleeding in patients with PT-INR ≤ 1.49 (n = 20), 1.50 - 1.99 (n = 32), 2.00 - 2.49 (n = 18), 2.50 - 2.99 (n = 10), and ≥ 3.00 (n = 16) were 1.0 (0.2, 5.9), 0.3 (0.1, 1.9), 1.0 (reference), 1.2 (0.2, 8.4), and 19.8 (2.0, 198.9), respectively, with a significant difference between ≥ 3.00 and reference. Among elderly Japanese patients with NVAF, PT-INR 2.0 - 3.0 may be associated with a clinically permissible risk of major bleeding while PT-INR ≥ 3.00 a significant risk. Further studies are warranted to determine whether the risk of major bleeding is significantly lower for PT-INR 2.50 - 2.99 than for PT-INR ≥ 3.00.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 22 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 22 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 6 27%
Student > Ph. D. Student 4 18%
Other 3 14%
Student > Postgraduate 2 9%
Lecturer 1 5%
Other 4 18%
Unknown 2 9%
Readers by discipline Count As %
Medicine and Dentistry 11 50%
Pharmacology, Toxicology and Pharmaceutical Science 3 14%
Nursing and Health Professions 1 5%
Biochemistry, Genetics and Molecular Biology 1 5%
Immunology and Microbiology 1 5%
Other 1 5%
Unknown 4 18%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 31 January 2016.
All research outputs
#20,303,950
of 22,842,950 outputs
Outputs from Journal of Pharmaceutical Health Care and Sciences
#120
of 144 outputs
Outputs of similar age
#331,662
of 394,940 outputs
Outputs of similar age from Journal of Pharmaceutical Health Care and Sciences
#3
of 3 outputs
Altmetric has tracked 22,842,950 research outputs across all sources so far. This one is in the 1st percentile – i.e., 1% of other outputs scored the same or lower than it.
So far Altmetric has tracked 144 research outputs from this source. They receive a mean Attention Score of 3.5. This one is in the 1st percentile – i.e., 1% of its peers scored the same or lower than it.
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