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Thromb Haemost 2014; 111(05): 833-841
DOI: 10.1160/TH13-12-1007
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Differences among western European countries in anticoagulation management of atrial fibrillation

Data from the PREFER IN AF Registry
Jean-Yves Le Heuzey
1   Cardiology and Arrhythmology, Georges Pompidou Hospital, René Descartes University, Paris, France
,
Bettina Ammentorp
2   Daiichi Sankyo Europe, Munich, Germany
,
Harald Darius
3   Department of Cardiology, Vivantes Hospital Neukölln, Berlin, Germany
,
Raffaele De Caterina
4   Institute of Cardiology G. d’Annunzio, University Chieti-Pescara, Italy
,
Richard John Schilling
5   Barts and St. Thomas Hospital, London, UK
,
Josef Schmitt
2   Daiichi Sankyo Europe, Munich, Germany
,
José Luis Zamorano
6   Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
,
Paulus Kirchhof
7   University of Birmingham Centre for Cardiovascular Sciences and SWBH NHS Trust, Birmingham, UK
8   Department of Cardiovascular Medicine, Hospital of the University of Münster, Germany
› Author Affiliations Financial support: PREFER in AF was sponsored by Daiichi Sankyo Europe GmbH. The members of the steering committee received honoraria for their advice in the planning and the analyses of the registry.
Further Information

Publication History

Received: 11 December 2013

Accepted after major revision: 20 February 2014

Publication Date:
01 December 2017 (online)

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Summary

Due to improved implementation of guidelines, new scoring approaches to improve risk categorisation, and introduction of novel oral anticoagulants, medical management of patients with atrial fibrillation (AF) is continuously improving. The PREFER in AF registry enrolled 7,243 consecutive patients with ECG-confirmed AF in seven European countries in 2012–2013 (mean age: 71.5 ± 10.7 years; 60.1% males; mean CHA2DS 2 -VASc score: 3.4). While patient characteristics were generally homogeneous across countries, anticoagulation management showed important differences: the proportion of patients taking vitamin K antagonists (VKAs) varied between 86.0% (in France) and 71.4% (in Italy). Warfarin was used predominantly in the UK and Italy (74.9% and 62.0%, respectively), phenprocoumon in Germany (74.1%), acenocoumarol in Spain (67.3%), and fluindione in France (61.8 %). The major sites for international normalised ratio (INR) measurements were biology laboratories in France anticoagulation clinics in Italy, Spain, and the UK, and physicians’ offices or self-measurement in Germany. Temporary VKA discontinuation and bridging with other anticoagulants was frequent (at least once in the previous 12 months for 22.9% of the patients, on average; ranging from 29.7% in Germany to 14.9% in the UK). Time in therapeutic range (TTR), defined as at least two of the last three available INR values between 2.0–3.0 prior to enrolment, ranged from 70.3% in Spain to 81.4% in Germany. TTR was constantly overestimated by physicians. While the type and half-lives of VKA as well as the mode of INR surveillance differed, overall quality of anticoagulation management by TTR was relatively homogenous in AF patients across countries.

Keywords

Registry - cross-sectional - anticoagulation - vitamin K antagonists - anticoagulation quality - INR
 

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