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
Researchers say the addition of NSAIDs to antidepressant treatment increased the risk of intracranial haemorrhage within 30 days of the combination starting.

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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

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

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