Korte uitleg
In de GAInN-studie hebben we de aanname gedaan dat patiënten die een goede TTR hadden, ook goed ingesteld zouden blijven. We zagen echter dat dat niet altijd het geval was.
Om te beoordelen in hoeverre een vroegere TTR het latere TTR-beloop zou voorspellen, heb ik de gegevens van 18.000 patiënten van de trombosedienst op een rij gezet. Daaruit kwam dat de relatie tussen een vorige en een huidige TTR niet zo groot was.
Lees dit artikel
Gepubliceerd als van Miert JHA, Veeger NJGM, Meijer K. Is the time in
therapeutic range on coumarins predicted by previous time in
therapeutic range? Research
and Practice in Thrombosis and Haemostasis. 2020 May 30;4(4):604–9.
Dit artikel is open-access beschikbaar en dus volledig gratis te lezen.
Abstract
Background
The benefit of vitamin K antagonists depends on the time within the therapeutic range (TTR). A patient’s previous TTR could be a factor in the decision to change the anticoagulation regimen. However, the predictive value of a previous TTR for a future TTR is not well established, nor is it clear which TTR should prompt action.
Objectives
To investigate the predictive performance of a TTR and identify a threshold below which no recovery of TTR should be expected.
Patients/Methods
From 18 031 patients who used acenocoumarol in a first‐line anticoagulation clinic, a TTR was calculated over multiple periods of 90, 180, and 365 days each. We assessed the correlation between baseline and later TTR and the separation between groups by quintile of baseline TTR. We describe the proportion of patients who obtain a TTR≥ 70% conditional on baseline TTR.
Results
The correlation between baseline and later TTR was 0.25 (95% confidence interval [CI], 0.24‐0.26), 0.27 (95% CI, 0.26‐0.28) and 0.34 (95% CI, 0.32‐0.35) for analyses over 90, 180, and 365 days. Corresponding c statistics for discrimination by baseline group were 0.60, 0.61, and 0.63. The probability to obtain a TTR ≥70% increased with baseline TTR: from 42% with a baseline TTR of 50%, to 65% when TTR was 100% (TTR calculated over 180 days).
Conclusions
We conclude that a current TTR hardly predicts a future TTR. Physicians and patients should deliberate together which probabilities to accept, take measures to improve TTR, and consider potential alternatives.