Abstract
BackgroundThe target ranges (TR) for anticoagulation with vitamin K antagonists (VKA) in the Netherlands were changed in 2016 from INR 2.0–3.5 (‘low intensity’) and INR 2.5–4.0 (‘high intensity’) to INR 2.0–3.0 and INR 2.5–3.5, respectively. AimTo assess the effect of the TR change on therapeutic quality control (TQC) in a Dutch regional thrombosis center taking care of approximately 3600–5500 patients annually.Methods: TQC of chronically treated patients was assessed as the average time in therapeutic range (TTR). Evaluations were performed for non-self-management (NSM), as well as self-management patients. INR percentiles were assessed from all INR determinations in all patients, i.e. including those of induction episodes and patients treated for a short-term. ResultsThe number of NSM patients treated chronically decreased gradually, while their average age increased, with a marginal but significant gradual increase in bleeding complications. In the period 2011–2015, i.e. before the TR change, there was a gradual increase of the TTR in NSM patients from 77.5% to 88.9% (low intensity) and from 75.3% to 84.1% (high intensity). In the same period, the median INR of all patients in the low and high intensity ranges decreased from 2.9 to 2.7, and from 3.3 to 3.2, respectively. The TTR in self-management patients remained virtually constant. After TR changes from 2016 on, the TTR of all NSM patients in the low and high intensity groups decreased to 77% and 70%, respectively, and median INRs decreased to 2.6 and 3.0, respectively. ConclusionsIntroduction of internationally harmonized target ranges in 2016 resulted in further lowering of median INR values in both target ranges. As expected, TTR was reduced slightly. These findings, together with a slight increase in average age and concomitant bleeding complications, suggest that the patients on long-term VKA treatment will require intensified monitoring and treatment.
Highlights
In the Netherlands, ambulant patients receiving treatment with vitamin K antagonists (VKA) are managed and controlled by regional thrombosis centers or anticoagulant clinics [1]
Beginning 2016, the two target ranges (TR) were changed for all patients in the Netherlands: the low intensity range was changed to INR 2.0–3.0, and the high intensity range to INR 2.5–3.5
The purpose of the present study was to assess the effect of the change on therapeutic quality control in a Dutch regional thrombosis center, i.e. the Thrombosis Center “Neder-Veluwe”, Ede, the Netherlands
Summary
In the Netherlands, ambulant patients receiving treatment with vitamin K antagonists (VKA) are managed and controlled by regional thrombosis centers or anticoagulant clinics [1]. Two methods were used to assess thera peutic quality control: a) time in therapeutic range by linear interpola tion (TTR); b) percentiles describing the distribution of all measured INRs. The target ranges (TR) for anticoagulation with vitamin K antagonists (VKA) in the Netherlands were changed in 2016 from INR 2.0–3.5 (‘low intensity’) and INR 2.5–4.0 (‘high intensity’) to INR 2.0–3.0 and INR 2.5–3.5, respectively. The median INR of all patients in the low and high intensity ranges decreased from 2.9 to 2.7, and from 3.3 to 3.2, respectively. After TR changes from 2016 on, the TTR of all NSM patients in the low and high intensity groups decreased to 77% and 70%, respectively, and median INRs decreased to 2.6 and 3.0, respectively. These findings, together with a slight increase in average age and concomitant bleeding complications, suggest that the patients on long-term VKA treatment will require intensified monitoring and treatment
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