Regional Differences in Frequency of Warfarin Therapy and Thromboembolism in Japanese Patients With Non-Valvular Atrial Fibrillation　– Analysis of the J-RHYTHM Registry –

• Inoue Hiroshi

  Second Department of Internal Medicine, Toyama University Hospital

• Atarashi Hirotsugu

  Nippon Medical School, Tama-Nagayama Hospital

• Kodani Eitaro

  Nippon Medical School, Tama-Nagayama Hospital

• Okumura Ken

  Department of Cardiology, Hirosaki University Graduate School of Medicine

• Yamashita Takeshi

  The Cardiovascular Institute

• Origasa Hideki

  Division of Biostatistics and Clinical Epidemiology, University of Toyama

• Sakurai Masayuki

  Department of Cardiology, Hokko Memorial Hospital

• Kawamura Yuichiro

  Health Administration Center, Asahikawa Medical University

• Kubota Isao

  Internal Medicine 1, Yamagata University School of Medicine

• Matsumoto Kazuo

  Cardiology Department, International Medical Center, Saitama Medical University

• Kaneko Yoshiaki

  Department of Medicine and Biological Science, Gunma University Graduate School of Medicine

• Ogawa Satoshi

  International University of Health and Welfare, Mita Hospital

• Aizawa Yoshifusa

  Division of Cardiology, Niigata University Graduate School of Medicine and Dental Science

• Chinushi Masaomi

  Graduate School of Health Science, Niigata University School of Medicine

• Kodama Itsuo

  Nagoya University

• Watanabe Eiichi

  Department of Cardiology, Fujita Health University School of Medicine

• Koretsune Yukihiro

  Institute for Clinical Research, National Hospital Organization, Osaka National Hospital

• Okuyama Yuji

  Department of Cardiology, Osaka General Medical Center

• Shimizu Akihiko

  Faculty of Health Sciences, Yamaguchi Graduate School of Medicine

• Igawa Osamu

  Department of Cardiovascular Medicine, Tottori University Hospital

• Bando Shigenobu

  Kagawa Prefectural Shirotori Hospital

• Fukatani Masahiko

  Department of Cardiology, Chikamori Hospital

• Saikawa Tetsunori

  Department of Clinical Examination and Diagnostics, Oita University

• Chishaki Akiko

  Department of Health Sciences, Faculty of Medical Sciences, Kyushu University

• on behalf of the J-RHYTHM Registry Investigators

Abstract

Background:The proportion of patients with atrial fibrillation (AF) treated with anticoagulation varies from country to country. In Japan, little is known about regional differences in frequency of warfarin use or prognosis among patients with non-valvular AF (NVAF).Methods and Results:In J-RHYTHM Registry, the number of patients recruited from each of 10 geographic regions of Japan was based on region population density. A total of 7,406 NVAF patients were followed up prospectively for 2 years. At baseline, significant differences in various clinical characteristics including age, sex, type of AF, comorbidity, and CHADS₂score, were detected among the regions. The highest mean CHADS₂score was recorded in Shikoku. Frequency of warfarin use differed between the regions (P<0.001), with lower frequencies observed in Hokkaido and Shikoku. Baseline prothrombin time international normalized ratio differed slightly but significantly between the regions (P<0.05). On univariate analysis, frequency of thromboembolic events differed among the regions (P<0.001), with the highest rate seen in Shikoku. An inverse correlation was detected between frequency of thromboembolic and of major hemorrhagic events (P=0.062). On multivariate analysis, region emerged as an independent risk for thromboembolism.Conclusions:Thromboembolic risk, frequency of warfarin use, and intensity and quality of warfarin treatment differed significantly between geographic regions of Japan. Region was found to be an independent predictor of thromboembolic events. (Circ J 2016; 80: 1548–1555)

Journal

• Circulation Journal

  Circulation Journal 80 (7), 1548-1555, 2016

  The Japanese Circulation Society

Keywords

• Atrial fibrillation
• Major hemorrhage
• Region
• Thromboembolism
• Warfarin

Details

• CRID: 1390282680085496320
• NII Article ID: 130005158915
• NII Book ID: AA11591968
• DOI: 10.1253/circj.cj-16-0300
• ISSN: 13474820
• ISSN: 13469843
• NDL BIB ID: 027438934
• PubMed: 27251064
• Web Site: http://id.ndl.go.jp/bib/027438934
• Web Site: https://ndlsearch.ndl.go.jp/books/R000000004-I027438934
• Web Site: https://www.jstage.jst.go.jp/article/circj/80/7/80_CJ-16-0300/_pdf
• Text Lang: en
• Data Source:
  • JaLC
  • NDL
  • Crossref
  • PubMed
  • CiNii Articles
  • KAKEN
• Abstract License Flag: Disallowed