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Is the time in therapeutic range using the ratio of tests equivalent to the Rosendaal method?

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dc.contributor.authorCaldeira, Daniel
dc.contributor.authorCruz, Inês
dc.contributor.authorMorgado, Gonçalo
dc.contributor.authorStuart, Bruno
dc.contributor.authorGomes, Ana Catarina
dc.contributor.authorMartins, Cristina
dc.contributor.authorJoão, Isabel
dc.contributor.authorPereira, Helder
dc.date.accessioned2022-02-07T15:58:53Z
dc.date.available2022-02-07T15:58:53Z
dc.date.issued2015
dc.descriptionCopyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.pt_PT
dc.description.abstractThe percentage of time in therapeutic range (TTR) is a measure of anticoagulation quality with vitamin K antagonists (VKAs). The method most commonly used in clinical trials is the Rosendaal TTR. However, the application of this method in daily practice for clinical decision lacks appropriate instruments. We aimed to evaluate the percentage of tests within the target international normalized ratio (INR) (tests ratio) as a surrogate of Rosendaal TTR. We performed an observational and retrospective study to evaluate the TTR according to the Rosendaal method and tests ratio. We included all outpatients who attended the cardiology anticoagulation clinic of a Portuguese hospital (2011-2013), whose target INR was 2.0-3.0. Three hundred and seventy-seven VKA-treated patients followed for a mean 1.3 years were evaluated. Rosendaal methold and tests ratio significantly correlated (Rho Spearman 0.88, P < 0.001), but the Bland-Altman plot evaluation showed a clinically relevant data dispersion [95% confidence interval (95% CI) -12.9 to 23.1] around a mean difference in TTR -5.1% using the tests ratio method. The linear regression Passing-Bablok confirmed the existence of significant data dispersion and systematic differences. The tests ratio less than 60% had a sensitivity of 91.6%, specificity of 72.3%, positive predictive value (PPV) of 72.2% and negative predictive value (NPV) of 91.6%, for the diagnosis of patients inadequately anticoagulated (Rosendaal TTR <60%). Tests ratio had a c-statistics of 0.94 (95% CI 0.91-0.96). Number of tests in 6 months had a c-statistics of 0.70 (95% CI 0.65-0.75). Tests ratio underestimated TTR in 5% and was not considered equivalent to Rosendaal TTR due to the high variability between methods. Nevertheless, the use of tests ratio less than 60% may be a reasonable option to detect inadequate anticoagulation, as it is a sensitive method and excluded most of the patients with adequate control.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationBlood Coagul Fibrinolysis. 2015 Dec;26(8):972-976pt_PT
dc.identifier.doi10.1097/MBC.0000000000000312pt_PT
dc.identifier.eissn1473-5733
dc.identifier.issn0957-5235
dc.identifier.urihttp://hdl.handle.net/10451/51155
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherWolters Kluwer Healthpt_PT
dc.relation.publisherversionhttps://journals.lww.com/bloodcoagulation/pages/default.aspxpt_PT
dc.subjectAnticoagulation qualitypt_PT
dc.subjectRosendaal methodpt_PT
dc.subjectTests ratiopt_PT
dc.subjectTime in therapeutic rangept_PT
dc.subjectVitamin K antagonistpt_PT
dc.subjectWarfarinpt_PT
dc.titleIs the time in therapeutic range using the ratio of tests equivalent to the Rosendaal method?pt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage976pt_PT
oaire.citation.issue8pt_PT
oaire.citation.startPage972pt_PT
oaire.citation.titleBlood Coagulation & Fibrinolysispt_PT
oaire.citation.volume26pt_PT
person.familyNameCaldeira
person.familyNameGomes
person.familyNamePereira
person.givenNameDaniel
person.givenNameAna Catarina
person.givenNameHelder
person.identifier.ciencia-idAA19-EC35-8D01
person.identifier.ciencia-id1D1D-DBAB-FAD4
person.identifier.orcid0000-0002-2520-5673
person.identifier.orcid0000-0001-7485-1244
person.identifier.orcid0000-0001-8656-4883
person.identifier.ridB-6870-2014
person.identifier.scopus-author-id36623384200
rcaap.rightsrestrictedAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublicationeba36bb8-5eb3-4ccc-88f8-bd7012d42382
relation.isAuthorOfPublication54084ebb-f10a-4cc5-8940-b5b41f450f86
relation.isAuthorOfPublicationf61e1990-9af4-4cdc-a0d4-c4f17fd69f15
relation.isAuthorOfPublication.latestForDiscoveryeba36bb8-5eb3-4ccc-88f8-bd7012d42382

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