What is the clinical evidence from this study?

Study design: Cohort. Population: Nonvalvular atrial fibrillation (n=40449). Intervention: Warfarin vs. Concomitant aspirin vs no aspirin; iTTR <70% vs ≥70%. Primary outcome: Annual incidence of complications in association with individual TTR (iTTR), INR variability, and aspirin use.

What does this research mean for the field?

Well-managed warfarin therapy in nonvalvular atrial fibrillation is associated with low annual rates of all-cause mortality (2.19%) and intracranial bleeding (0.44%), remaining a valid alternative for stroke prophylaxis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the efficacy and safety of warfarin therapy for stroke prevention in patients with nonvalvular atrial fibrillation, focusing on complications and INR control.

April 20, 2016JAMA CardiologyOpen Access

Outcomes in a Warfarin-Treated Population With Atrial Fibrillation

Q: What are the key findings of this study?

Well-managed warfarin therapy in nonvalvular atrial fibrillation was associated with low annual rates of all-cause mortality (2.19%) and intracranial bleeding (0.44%).

Q: What does this research mean for the field?

Well-managed warfarin therapy in nonvalvular atrial fibrillation is associated with low annual rates of all-cause mortality (2.19%) and intracranial bleeding (0.44%), remaining a valid alternative for stroke prophylaxis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the efficacy and safety of warfarin therapy for stroke prevention in patients with nonvalvular atrial fibrillation, focusing on complications and INR control.

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Why the study?

What are the rates of complications and the impact of INR control and concomitant aspirin use in patients with nonvalvular AF treated with well-managed warfarin?

Population

40,449 patients starting warfarin therapy owing to nonvalvular atrial fibrillation, mean age 72.5, 40.0%…

Design

Cohort

Follow-up

Until treatment cessation, death, or the end of the study

Key result

Well-managed warfarin therapy in nonvalvular atrial fibrillation was associated with low annual rates of all-cause mortality (2.19%) and intracranial bleeding (0.44%).

Authors

FBFredrik Björck HRHenrik Renlund GLGregory Y.H. Lip

Discussion

Member takes

Overview

May support well-managed warfarin as a safe option in nonvalvular AF; leaves open optimal aspirin co-prescription and INR targets.

Key Points

To assess the efficacy and safety of warfarin therapy for stroke prevention in patients with nonvalvular atrial fibrillation, focusing on complications and INR control.
Retrospective multicenter cohort study conducted using Swedish registries, analyzing data from 40,449 patients on warfarin therapy.
Patients monitored for complications related to INR control and concomitant aspirin use from January 2006 to December 2011.
Annual incidences of complications, specifically major bleeding and thromboembolism, were evaluated based on individualized TTR.
Annual all-cause mortality rate was 2.19% (95% CI 2.07-2.31) and intracranial bleeding rate was 0.44% (95% CI 0.39-0.49).
Concomitant aspirin users showed major bleeding at a rate of 3.07% (95% CI 2.70-3.44) with a thromboembolism rate of 4.90% (95% CI 4.43-5.37).
In patients with iTTR less than 70%, major bleeding and thromboembolism rates were 3.81% (95% CI 3.51-4.11) and 4.41% (95% CI 4.09-4.73) respectively, highlighting a need for careful INR management.

Study Design

Type

Cohort (n=40,449)

Multicenter

Yes

Structured PICO

What are the rates of complications and the impact of INR control and concomitant aspirin use in patients with nonvalvular AF treated with well-managed warfarin?

Population

40,449 patients starting warfarin therapy owing to nonvalvular atrial fibrillation, mean age 72.5, 40.0% female, mean CHA2DS2-VASc score 3.3, based on Swedish registries.

Intervention

Warfarin therapy with and without concomitant therapy with aspirin

Outcome

Annual incidence of complications (all-cause mortality, intracranial bleeding, major bleeding, thromboembolism) in association with individual TTR (iTTR), INR variability, and aspirin usehard clinical

Well-managed warfarin therapy in nonvalvular atrial fibrillation is associated with low complication rates, though risks are elevated with concomitant aspirin use, renal failure, and poor INR control.

Cite This Study

Björck et al. (2016) conducted a cohort in Nonvalvular atrial fibrillation (n=40,449). Warfarin vs. Concomitant aspirin vs no aspirin; iTTR <70% vs ≥70% was evaluated on Annual incidence of complications in association with individual TTR (iTTR), INR variability, and aspirin use. Well-managed warfarin therapy in nonvalvular atrial fibrillation was associated with low annual rates of all-cause mortality (2.19%) and intracranial bleeding (0.44%).

synapsesocial.com/papers/6a1678e3805322efe95d3df3 https://doi.org/10.1001/jamacardio.2016.0199

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April 20, 2016JAMA CardiologyOpen Access

Outcomes in a Warfarin-Treated Population With Atrial Fibrillation

View Full Paper

Ask AI

Bookmark

Why the study?

What are the rates of complications and the impact of INR control and concomitant aspirin use in patients with nonvalvular AF treated with well-managed warfarin?

Population

40,449 patients starting warfarin therapy owing to nonvalvular atrial fibrillation, mean age 72.5, 40.0%…

Design

Cohort

Follow-up

Until treatment cessation, death, or the end of the study

Key result

Well-managed warfarin therapy in nonvalvular atrial fibrillation was associated with low annual rates of all-cause mortality (2.19%) and intracranial bleeding (0.44%).

Authors

FBFredrik Björck HRHenrik Renlund GLGregory Y.H. Lip

Discussion

Member takes

Overview

May support well-managed warfarin as a safe option in nonvalvular AF; leaves open optimal aspirin co-prescription and INR targets.

Key Points

To assess the efficacy and safety of warfarin therapy for stroke prevention in patients with nonvalvular atrial fibrillation, focusing on complications and INR control.
Retrospective multicenter cohort study conducted using Swedish registries, analyzing data from 40,449 patients on warfarin therapy.
Patients monitored for complications related to INR control and concomitant aspirin use from January 2006 to December 2011.
Annual incidences of complications, specifically major bleeding and thromboembolism, were evaluated based on individualized TTR.
Annual all-cause mortality rate was 2.19% (95% CI 2.07-2.31) and intracranial bleeding rate was 0.44% (95% CI 0.39-0.49).
Concomitant aspirin users showed major bleeding at a rate of 3.07% (95% CI 2.70-3.44) with a thromboembolism rate of 4.90% (95% CI 4.43-5.37).
In patients with iTTR less than 70%, major bleeding and thromboembolism rates were 3.81% (95% CI 3.51-4.11) and 4.41% (95% CI 4.09-4.73) respectively, highlighting a need for careful INR management.

Study Design

Type

Cohort (n=40,449)

Multicenter

Yes

Structured PICO

What are the rates of complications and the impact of INR control and concomitant aspirin use in patients with nonvalvular AF treated with well-managed warfarin?

Population

40,449 patients starting warfarin therapy owing to nonvalvular atrial fibrillation, mean age 72.5, 40.0% female, mean CHA2DS2-VASc score 3.3, based on Swedish registries.

Intervention

Warfarin therapy with and without concomitant therapy with aspirin

Outcome

Cite This Study

synapsesocial.com/papers/6a1678e3805322efe95d3df3 https://doi.org/10.1001/jamacardio.2016.0199

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