Internal Med Medical News about atrial fibrillation; warfarin anticoagulation

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The Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation
Annals of Internal Medicine, 09/01/09

Singer DE et al. – Expected net clinical benefit of warfarin therapy is highest among patients with the highest untreated risk for stroke, which includes the oldest age category. Risk assessment that incorporates both risk for thromboembolism and risk for intracranial hemorrhage provides a more quantitatively informed basis for the decision on antithrombotic therapy in patients with atrial fibrillation. Methods

Mixed retrospective and prospective cohort study of patients with atrial fibrillation between 1996 and 2003.
Patients: 13 559 adults with nonvalvular atrial fibrillation.
Warfarin exposure, patient characteristics, CHADS2 score (1 point for each of congestive heart failure, hypertension, age, and diabetes and 2 points for stroke), and outcome events were ascertained from health plan records and databases.
Net clinical benefit was defined as the annual rate of ischemic strokes and systemic emboli prevented by warfarin minus intracranial hemorrhages attributable to warfarin, multiplied by an impact weight.

Results

Patients accumulated more than 66 000 person–years of follow–up.
The adjusted net clinical benefit of warfarin for the cohort overall was 0.68% per year.
Adjusted net clinical benefit was greatest for patients with a history of ischemic stroke and for those 85 years or older.
The net clinical benefit of warfarin increased from essentially zero in CHADS2 stroke risk categories 0 and 1 to 2.22% per year in CHADS2 categories 4 to 6.

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