Well-managed warfarin still useful for stroke prevention

A study of 40,000 patients with atrial fibrillation suggests that warfarin is a valid treatment for stroke prevention.

Concomitant use of antidepressants and non-steroidal anti-inflammatory drugs (NSAIDs) is associated with a significantly increased risk of intracranial haemorrhage (ICH). In the image, axial CT scan of intracranial haemorrhage

Studies of patients with atrial fibrillation (AF) have shown that non-vitamin K oral anticoagulants carry a lower risk of intracranial bleeding than warfarin. But the mean time in therapeutic range (TTR) in these studies was below 70%, suggesting suboptimal warfarin management. 

Researchers from Sweden conducted a retrospective cohort study using data on 40,449 AF patients treated with warfarin over a six-year period to assess the relationship between warfarin management and complications. 

They found that patients with an individual TTR above 70% had a significantly lower incidence of treatment complications. For example, in these patients, the rate of major bleeding was 1.61% compared with 3.81% among those with a lower individual TTR. 

Reporting in JAMA Cardiology  (online, 20 April 2016)[1]
, the team say the findings suggest that well-managed warfarin treatment remains a valid alternative in patients with AF who require stroke prevention therapy.

References

[1] Bjorck F, Renlund H, Lip GYH et al. Outcomes in warfarin-treated population with atrial fibrillation. JAMA Cardiology 2016. doi: 10.1001/jamacardio.2016.0199

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Citation
Clinical Pharmacist, CP, May 2016, Vol 8, No 5;8(5):DOI:10.1211/PJ.2016.20201087