Quality of anticoagulation with vitamin K antagonists in Spain: A systematic review with meta-analysis of national registries

IF 2.6 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica Pub Date : 2025-06-03 DOI:10.1016/j.medcli.2025.107031

José Miguel Rivera-Caravaca , Danilo Menichelli , Daniele Pastori , Eva Soler-Espejo , María Asunción Esteve-Pastor , David Vivas , Inmaculada Roldán , Manuel Anguita , José Luis Ferreiro , Vanessa Roldán , Francisco Marín , on behalf of the Working Group on Cardiovascular Thrombosis of the Spanish Society of Cardiology

{"title":"Quality of anticoagulation with vitamin K antagonists in Spain: A systematic review with meta-analysis of national registries","authors":"José Miguel Rivera-Caravaca , Danilo Menichelli , Daniele Pastori , Eva Soler-Espejo , María Asunción Esteve-Pastor , David Vivas , Inmaculada Roldán , Manuel Anguita , José Luis Ferreiro , Vanessa Roldán , Francisco Marín , on behalf of the Working Group on Cardiovascular Thrombosis of the Spanish Society of Cardiology","doi":"10.1016/j.medcli.2025.107031","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Vitamin K antagonists (VKAs) depend on appropriate time in therapeutic range (TTR). We reviewed studies in Spain providing data on the quality of oral anticoagulation with VKA in atrial fibrillation (AF) patients, to present an overview of the quality of this therapy in our country.</div></div><div><h3>Methods</h3><div>Systematic review and meta-analysis of national studies. We searched PubMed, Web of Science and Google Scholar databases for studies published in the last 10 years, until June 2024. We reported the mean pooled TTR and proportion of international normalized ratios (INRs) in range (PINRR), as well as the pooled prevalence of poor quality of VKA therapy.</div></div><div><h3>Results</h3><div>Seven studies were included in the analysis, for an overall cohort of 6953 patients (mean age 73.6–83 years). The pooled analysis gave a mean TTR of 63.22% (95% confidence interval [CI] 46.55–79.89) and a mean PINRR of 60.53% (95% CI 44.40–76.65). Accordingly, the pooled prevalence of a TTR <65% was 50.01% (95% CI 45.36–54.65), and the pooled prevalence of a PINRR <60% was 46.90% (95% CI 41.56–52.31). Similar results were observed in a sensitivity analysis performed including only those studies fulfilling very similar inclusion/exclusion criteria (<em>n</em>  <!-->5).</div></div><div><h3>Conclusion</h3><div>The mean TTR and PINRR of AF patients on VKAs in Spain were below the recommended standards. Nearly 50% of patients showed poor anticoagulation control, remaining exposed to low-quality therapy and complications related to AF.</div></div>","PeriodicalId":18578,"journal":{"name":"Medicina Clinica","volume":"165 3","pages":"Article 107031"},"PeriodicalIF":2.6000,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medicina Clinica","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0025775325002593","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Vitamin K antagonists (VKAs) depend on appropriate time in therapeutic range (TTR). We reviewed studies in Spain providing data on the quality of oral anticoagulation with VKA in atrial fibrillation (AF) patients, to present an overview of the quality of this therapy in our country.

Methods

Systematic review and meta-analysis of national studies. We searched PubMed, Web of Science and Google Scholar databases for studies published in the last 10 years, until June 2024. We reported the mean pooled TTR and proportion of international normalized ratios (INRs) in range (PINRR), as well as the pooled prevalence of poor quality of VKA therapy.

Results

Seven studies were included in the analysis, for an overall cohort of 6953 patients (mean age 73.6–83 years). The pooled analysis gave a mean TTR of 63.22% (95% confidence interval [CI] 46.55–79.89) and a mean PINRR of 60.53% (95% CI 44.40–76.65). Accordingly, the pooled prevalence of a TTR <65% was 50.01% (95% CI 45.36–54.65), and the pooled prevalence of a PINRR <60% was 46.90% (95% CI 41.56–52.31). Similar results were observed in a sensitivity analysis performed including only those studies fulfilling very similar inclusion/exclusion criteria (n = 5).

Conclusion

The mean TTR and PINRR of AF patients on VKAs in Spain were below the recommended standards. Nearly 50% of patients showed poor anticoagulation control, remaining exposed to low-quality therapy and complications related to AF.

查看原文本刊更多论文

西班牙维生素K拮抗剂抗凝的质量：一项对国家登记的荟萃分析的系统评价

维生素K拮抗剂（VKAs）依赖于适当的治疗范围时间（TTR）。我们回顾了西班牙的研究，提供了房颤（AF）患者口服VKA抗凝治疗质量的数据，以概述我国这种治疗的质量。方法系统回顾和荟萃分析国家研究。我们在PubMed、Web of Science和b谷歌Scholar数据库中搜索了过去10年（截止到2024年6月）发表的研究。我们报告了平均合并TTR和国际标准化比率（INRs）在范围内的比例（PINRR），以及VKA治疗质量差的合并患病率。结果7项研究纳入分析，共6953例患者（平均年龄73.6-83岁）。合并分析的平均TTR为63.22%(95%可信区间[CI] 46.55-79.89)，平均PINRR为60.53% （95% CI 44.40-76.65）。因此，TTR <；65%的合并患病率为50.01% (95% CI 45.36-54.65), PINRR <；60%的合并患病率为46.90% （95% CI 41.56-52.31）。在敏感性分析中也观察到类似的结果，仅包括那些满足非常相似的纳入/排除标准的研究（n = 5）。结论西班牙vka治疗AF患者的平均TTR和PINRR均低于推荐标准。近50%的患者抗凝控制不良，仍然暴露于低质量的治疗和房颤相关的并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Medicina Clinica 医学-医学：内科

CiteScore

3.10

自引率

5.10%

发文量

295

审稿时长

22 days

期刊介绍： Medicina Clínica, fundada en 1943, es una publicación quincenal dedicada a la promoción de la investigación y de la práctica clínica entre los especialistas de la medicina interna, así como otras especialidades. Son características fundamentales de esta publicación el rigor científico y metodológico de sus artículos, la actualidad de los temas y, sobre todo, su sentido práctico, buscando siempre que la información sea de la mayor utilidad en la práctica clínica.