Warfarin effective for stroke prevention in patients with atrial fibrillation

The blood thinner warfarin can be safely and effectively used to prevent stroke in patients with atrial fibrillation, according to an article in the November 26 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, multiple randomized clinical trials have demonstrated warfarin therapy to be highly effective in reducing the risk of ischemic stroke in patients with atrial fibrillation (an electrical rhythm disturbance of the heart that causes an irregular heartbeat). In these trials, treatment was associated with relatively low rates of bleeding, which is the major possible adverse effect of warfarin treatment. However, concerns persist about the effectiveness and safety of warfarin in persons treated in usual clinical care since the randomized trials enrolled highly selected patients, included few very elderly patients, and closely monitored patients' level of anticoagulation. This has important clinical implications since atrial fibrillation occurs commonly, particularly among the elderly.

Alan S. Go, M.D., of Kaiser Permanente of Northern California, Oakland, Calif., and colleagues evaluated the effect of warfarin on risk of thromboembolism (the blocking of a blood vessel, e.g., in the brain, by a blood clot), hemorrhage, and death in patients with atrial fibrillation within a usual care setting. The study was conducted between July 1, 1996, and December 31, 1997, with follow-up through August 31, 1999, in a large integrated health care system in Northern California. Of 13,559 adults with atrial fibrillation (not due to a problem with a heart valve), 11,526 were studied, 43 percent of whom were women. The average age was 71 years.

Among 11,526 patients, 397 thromboembolic events (372 ischemic strokes) occurred, and warfarin therapy was associated with a 51 percent lower risk of thromboembolism and stroke compared with no warfarin therapy (either no antithrombotic therapy or

Contact: Laura Marshall
JAMA and Archives Journals

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