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The association of high-normal international-normalized-ratio (INR) with mortality in patients referred for coronary angiography

Aims The international-normalized-ratio (INR) is typically used to monitor patients on warfarin or related oral anticoagulant therapy. The aim of our study was to investigate the association of the INR with mortality in coronary artery disease (CAD) patients not on oral anticoagulant therapy. Method...

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Main Authors: Delgado Gonzales de Kleber, Graciela (Author) , Krämer, Bernhard (Author) , März, Winfried (Author) , Kleber, Marcus E. (Author)
Format: Article (Journal)
Language:English
Published: August15, 2019
In: PLOS ONE
Year: 2019, Volume: 14, Issue: 8
ISSN:1932-6203
DOI:10.1371/journal.pone.0221112
Online Access:Verlag, Volltext: https://doi.org/10.1371/journal.pone.0221112
Verlag, Volltext: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221112
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Author Notes:Graciela E. Delgado, Andreas Zirlik, Rudolf Gruber, Thomas Scheffold, Bernhard K. Krämer, Winfried März, Marcus E. Kleber

MARC

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245 1 4 |a The association of high-normal international-normalized-ratio (INR) with mortality in patients referred for coronary angiography  |c Graciela E. Delgado, Andreas Zirlik, Rudolf Gruber, Thomas Scheffold, Bernhard K. Krämer, Winfried März, Marcus E. Kleber 
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520 |a Aims The international-normalized-ratio (INR) is typically used to monitor patients on warfarin or related oral anticoagulant therapy. The aim of our study was to investigate the association of the INR with mortality in coronary artery disease (CAD) patients not on oral anticoagulant therapy. Methods and results Between 1997 to 2000 the LUdwigshafen RIsk and Cardiovascular Health (LURIC) study enrolled 3316 patients of German ancestry that had been referred for coronary angiography. We excluded patients on coumarin therapy (n = 222) and patients with an INR more than 5 standard deviations (SD) away from the mean (n = 30). During a median follow-up of 9.9 years, 884 patients died, 547 patients from cardiovascular causes. After adjustment for cardiovascular risk factors the INR was associated with all-cause mortality in all patients and the CAD positive group with HRs (95% CI) of 1.14(1.07-1.21) and 1.16(1.09-1.23) per 1-SD increase, respectively. Adjustment for NT-proBNP rendered the association insignificant. Conclusion In LURIC, the INR was positively associated with mortality in patients with prevalent CAD not on oral anticoagulant therapy as well as in patients without CAD. Adjustment for NT-proBNP abolished the association suggesting clinical or subclinical heart failure strongly contributing to increased INR and higher mortality. 
650 4 |a Anticoagulant therapy 
650 4 |a Coronary heart disease 
650 4 |a Death rates 
650 4 |a Diabetes mellitus 
650 4 |a Heart failure 
650 4 |a Hypertension 
650 4 |a Liver diseases 
650 4 |a Serine proteases 
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