Prevalence and Predictors of Warfarin Use in Patients With Atrial Fibrillation at Low or Intermediate Risk and Relation to Thromboembolic Events
dc.contributor.author | Chae, Sanders H. | en_US |
dc.contributor.author | Froehlich, James B. | en_US |
dc.contributor.author | Morady, Fred | en_US |
dc.contributor.author | Oral, Hakan | en_US |
dc.date.accessioned | 2011-11-10T15:32:33Z | |
dc.date.available | 2012-12-03T21:17:29Z | en_US |
dc.date.issued | 2011-10 | en_US |
dc.identifier.citation | Chae, Sanders H.; Froehlich, James; Morady, Fred; Oral, Hakan (2011). "Prevalence and Predictors of Warfarin Use in Patients With Atrial Fibrillation at Low or Intermediate Risk and Relation to Thromboembolic Events." Clinical Cardiology 34(10): 640-644. <http://hdl.handle.net/2027.42/86871> | en_US |
dc.identifier.issn | 0160-9289 | en_US |
dc.identifier.issn | 1932-8737 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/86871 | |
dc.description.abstract | Background: According to the American College of Cardiology/American Heart Association/European Society of Cardiology guidelines, the choice of aspirin or warfarin to prevent thromboembolic events (TEs) in patients with nonrheumatic atrial fibrillation (AF) should be based on the CHADS 2 score. The purpose of this study was to determine the predictors of warfarin use in patients with AF at low (CHADS 2 =0) or intermediate (CHADS 2 =1) risk for TEs. Hypothesis: Warfarin use is low in intermediate‐ and low‐risk patients. Methods: Clinical characteristics of 3086 consecutive patients (mean age, 70 ± 13 years) with nonrheumatic AF from an academic multispecialty practice were determined between 2006 and 2008 through individual chart review. Patients were identified based on an inpatient or outpatient encounter, in which a billing diagnosis code of AF or atrial flutter (AFl) was recorded. The decision for anticoagulation was at the discretion of the primary care physician or cardiologist. No intervention to guide anticoagulant therapy was made. Results: Warfarin was prescribed in 180/497 low‐risk patients (36%), and in 646/938 intermediate‐risk patients (69%). Among high‐risk patients (CHADS 2 ≥2), warfarin was used in 792/968 patients (82%) with a CHADS 2 = 2, in 343/410 patients (84%) with a CHADS 2 =3, and in 225/273 patients (82%) with a CHADS 2 ≥4. On multivariate analysis, independent predictors of warfarin use in low‐risk patients were nonparoxysmal AF (odds ratio [OR]: 5.02, P< 0.0001) and age between 65 and 74 years (OR: 2.21, P< 0.0001). Among intermediate‐risk patients, congestive heart failure (OR: 7.34, P< 0.0001), nonparoxysmal AF (OR: 4.04, P< 0.0001), coronary artery disease (OR: 2.53, P< 0.0001), age between 65 and 74 years (OR: 1.68, P = 0.002), and female gender (OR: 1.69, P = 0.002) were independent predictors of warfarin use. Lack of warfarin use (OR: 4.9, P< 0.001) and female gender (OR: 2.0, P = 0.03) were associated with a higher risk of TEs in intermediate‐risk patients. None of the CHADS 2 parameters was predictive of TEs. Warfarin was not associated with reduction in TEs in low‐risk patients. Warfarin use did not have a significant effect on bleeding. Conclusions: Although either aspirin or warfarin is recommended to prevent TEs in patients with AF at intermediate risk for TEs, warfarin is preferred in the majority of patients in general practice. Lack of warfarin use is associated with a higher risk of TEs in intermediate‐risk patients with AF. The adoption of new oral anticoagulants that have lower risk of major hemorrhage than warfarin for low‐ or intermediate‐risk AF patients remains to be determined. © 2011 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose. | en_US |
dc.publisher | Wiley Periodicals, Inc. | en_US |
dc.title | Prevalence and Predictors of Warfarin Use in Patients With Atrial Fibrillation at Low or Intermediate Risk and Relation to Thromboembolic Events | en_US |
dc.type | Article | en_US |
dc.rights.robots | IndexNoFollow | en_US |
dc.subject.hlbsecondlevel | Internal Medicine and Specialities | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan | en_US |
dc.contributor.affiliationum | Cardiovascular Medicine, CVC, SPC5853 University of Michigan 1500 E. Medical Center Dr. Ann Arbor, MI 48109‐5853 | en_US |
dc.contributor.affiliationother | Department of Cardiovascular Medicine, University of South Florida, Tampa, Florida | en_US |
dc.identifier.pmid | 21994084 | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/86871/1/20967_ftp.pdf | |
dc.identifier.doi | 10.1002/clc.20967 | en_US |
dc.identifier.source | Clinical Cardiology | en_US |
dc.identifier.citedreference | Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace. 2006; 8: 651 – 745. | en_US |
dc.identifier.citedreference | Stroke Prevention in Atrial Fibrillation Study. Final results. Circulation. 1991; 84: 527 – 539. | en_US |
dc.identifier.citedreference | Connolly SJ, Laupacis A, Gent M, et al. Canadian Atrial Fibrillation Anticoagulation (CAFA) Study. J Am CollCardiol. 1991; 18: 349 – 355. | en_US |
dc.identifier.citedreference | Hart RG, Pearce LA, Aguilar MI. Meta‐analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007; 146: 857 – 867. | en_US |
dc.identifier.citedreference | Hylek EM, Evans‐Molina C, Shea C, et al. Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation. 2007; 115: 2689 – 2696. | en_US |
dc.identifier.citedreference | Gage BF, Van Walraven C, Pearce L, et al. Selecting patients with atrial fibrillation for anticoagulation: stroke risk stratification in patients taking aspirin. Circulation. 2004; 110: 2287 – 2292. | en_US |
dc.identifier.citedreference | Lewis WR, Fonarow GC, LaBresh KA, et al. Differential use of warfarin for secondary stroke prevention in patients with various types of atrial fibrillation. Am J Cardiol. 2009; 103: 227 – 231. | en_US |
dc.identifier.citedreference | Waldo AL, Becker RC, Tapson VF, et al. Hospitalized patients with atrial fibrillation and a high risk of stroke are not being provided with adequate anticoagulation. J Am Coll Cardiol. 2005; 46: 1729 – 1736. | en_US |
dc.identifier.citedreference | Camm AJ, Kirchof P, Lip GYH, et al. Guidelines for the management of atrial fibrillation. Eur Heart J. 2010; 31: 2369 – 2429. | en_US |
dc.identifier.citedreference | Wann LS, Curtis AB, Ellenbogen KA, et al. 2011 ACCF/AHA/ HRS focused update on the management of patients with atrial fibrillation (update on dabigatran). Circulation. 2011; 123: 1144 – 1150. | en_US |
dc.identifier.citedreference | Singer DE, Chang Y, Fang MC, et al. The net clinical benefit of warfarin anticoagulation in atrial fibrillation. Ann Intern Med. 2009; 151: 297 – 305. | en_US |
dc.identifier.citedreference | Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009; 361: 1139 – 1151. | en_US |
dc.identifier.citedreference | Connolly SJ, Eikelboom J, Joyner C, et al. Apixaban in atrial fibrillation. N Engl J Med. 2011; 364: 806 – 817. | en_US |
dc.identifier.citedreference | Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001; 285: 2864 – 2870. | en_US |
dc.identifier.citedreference | Brass LM, Krumholz HM, Scinto JM, et al. Warfarin use among patients with atrial fibrillation. Stroke. 1997; 28: 2382 – 2389. | en_US |
dc.identifier.citedreference | Lee BH, Park JS, Park JH, et al. The effect and safety of the antithrombotic therapies in patients with atrial fibrillation and CHADS score 1. J CardiovascElectrophysiol. 2010; 21: 501 – 507. | en_US |
dc.owningcollname | Interdisciplinary and Peer-Reviewed |
Files in this item
Remediation of Harmful Language
The University of Michigan Library aims to describe library materials in a way that respects the people and communities who create, use, and are represented in our collections. Report harmful or offensive language in catalog records, finding aids, or elsewhere in our collections anonymously through our metadata feedback form. More information at Remediation of Harmful Language.
Accessibility
If you are unable to use this file in its current format, please select the Contact Us link and we can modify it to make it more accessible to you.