![]() ![]() ![]() ![]() Retrieving case patients developing major bleeding In the present study, we aimed to assess whether elderly Japanese patients with PT-INR 2.5 – 3.0 have different risk of major bleeding compared to those with PT-INR 2.0 – 2.5 or ≥ 3.0. With the availability of electronic medical record systems in community hospitals, hospital pharmacists can now conduct case-control studies using real-world clinical data. Indeed, an optimal PT-INR range of 2.0 – 3.0 for warfarin was first proposed from case-control studies conducted by Hyleck et al. Ī case-control study design would complement prospective randomized or cohort studies in assessing the risk of outcomes with low event rates (such as major bleeding caused by warfarin). However, there is a relative lack of information regarding the bleeding risk at PT-INR 2.6 – 3.0 in elderly Japanese patients receiving warfarin. Recent large cohort studies conducted in Japanese patients with NVAF confirmed that PT-INR 2.0 – 3.0 should be considered the target range for non-elderly Japanese patients, considering the balance between risk of bleeding and anti-thrombotic efficacy. Unfortunately, the study estimated the risk of major bleeding for PT-INR ≥ 2.60 as a whole, and it remains unclear if PT-INR 2.6 – 3.0 would be associated with an increased risk compared to PT-INR 1.6 – 2.6. One of the reasons for recommending a lower PT-INR range (1.6 – 2.6) for elderly Japanese patients is that an observational study on approximately 200 Japanese NVAF patients of all ages for the secondary prevention of stroke demonstrated an increased risk of major bleeding for PT-INR ≥ 2.60. While the prothrombin time-international normalized ratio (PT-INR) range of 2.0 – 3.0 is recommended for Caucasians regardless of age and for non-elderly Japanese patients, the range of 1.6 – 2.6 has been recommended for elderly (age ≥ 70 years) Japanese patients. Nevertheless, debate continues regarding the optimal intensity of warfarin therapy in elderly Japanese patients with NVAF. As a result, warfarin is still most frequently used in these patients. While many non-vitamin K antagonist oral anticoagulants (NOACs) have become available, their use for elderly patients is still limited because of a paucity of information regarding their safety profiles in the elderly population. Oral anticoagulant therapy has been shown to be effective in reducing the risk of thromboembolic events in patients of all age groups. Non-valvular atrial fibrillation (NVAF) is the most prevalent arrhythmia in the elderly and poses substantial morbidity and mortality risks because of an increase in cardiogenic thromboembolic complications. ![]()
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