Abstract
Vitamin K antagonist such as warfarin reduces the risk of stroke in atrial fibrillation (AF) patients. Since warfarin has a narrow therapeutic index, its administration needs to be regularly monitored to avoid any adverse clinical outcomes such as stroke and bleeding. The quality of anticoagulation control with warfarin therapy can be measured by using time in therapeutic range (TTR). This review focuses on the prevalence of AF, quality of anticoagulation control (TTR) and adverse clinical outcome in AF patients within different ethnic groups receiving warfarin therapy for stroke prevention. A literature search was conducted in Embase and PubMed using keywords of “prevalence,” “atrial fibrillation,” “stroke prevention,” “oral anticoagulants,” “warfarin,” “ethnicities,” “race” “time in therapeutic range,” “adverse clinical outcome,” “stroke, bleeding.” Articles published by 1st February 2020 were included. Forty-one studies were included in the final review consisting of AF prevalence (n = 14 studies), time in therapeutic range (n = 18 studies), adverse clinical outcome (n = 9 studies) within different ethnic groups. Findings indicate that higher prevalence of AF but better anticoagulation control among the Whites as compared to other ethnicities. Of note, non-whites had higher risk of strokes and bleeding outcomes while on warfarin therapy. Addressing disparities in prevention and healthcare resource allocation could potentially improve AF-related outcomes in minorities.
Highlights
Atrial fibrillation (AF) is an atrial tachyarrhythmia that has an uncoordinated atrial activation, with consequent atrial mechanical function deterioration [1]
The use of Vitamin K antagonist (VKA) in AF patients is associated with a reduction in the risk of thromboembolic complications when time in therapeutic range (TTR) >70% is achieved [5]
The score can be used to aid decision making by identifying those patients who would probably do well when treated with VKA or, those who would need additional interventions to achieve good INR control or to be initiated on/switched to a non-VKA oral anticoagulant (NOAC) [7]
Summary
Atrial fibrillation (AF) is an atrial tachyarrhythmia that has an uncoordinated atrial activation, with consequent atrial mechanical function deterioration [1]. A clinical scoring system, the SAMe-TT2R2 score was developed in 2013 that presents the most common clinical and demographic factors that might influence anticoagulation control in AF patients [7] and nonwhite ethnicity is included in this scoring system. The score can be used to aid decision making by identifying those patients who would probably do well when treated with VKA (achieving a high TTR, >65%) or, those who would need additional interventions to achieve good INR control or FIGURE 1 | Selection of studies included in the review. The prevalence of AF, quality of anticoagulation and adverse clinical outcome among different ethnic groups varies and was seen to be poor among non-white ethnicities This is the first review that reports on the prevalence of AF, the quality of anticoagulation control (TTR) and adverse clinical outcome among different ethnic groups receiving warfarin therapy for stroke prevention
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