Anticoagulation after Anterior Myocardial Infarction and the Risk of Stroke
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Key result
Among elderly patients who survived an anterior myocardial infarction, the use of warfarin for up to 90 days post-discharge did not significantly reduce the risk of ischemic stroke (HR 0.68).
Why the study?
Does warfarin use up to 90 days post-MI reduce the risk of ischemic stroke in patients surviving an anterior myocardial infarction?
Population
10,383 patients who survived hospitalization for an acute myocardial infarction in Ontario, Canada…
Comparison
Warfarin use at discharge and followed for up to… vs Non-use of warfarin
Design
Cohort
Follow-up
4 years
Authors
Discussion
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Implication
Short-term warfarin was not associated with lower stroke risk after anterior MI; leaves open whether RCTs would demonstrate benefit in selected patients.
Study Design
Type
Cohort (n=10,383)
Multicenter
Yes
Structured PICO
Does warfarin use up to 90 days post-MI reduce the risk of ischemic stroke in patients surviving an anterior myocardial infarction?
P
Population
10,383 patients who survived hospitalization for an acute myocardial infarction (MI) in Ontario, Canada, including a subset of 2,942 patients with anterior MI and 1,483 patients aged 66 and older for the warfarin analysis. Mean age 66.46 years, 65.5% male.
I
Intervention
Warfarin use at discharge and followed for up to 90 days post-MI
C
Comparator
Non-use of warfarin
O
Outcome
Four-year ischemic stroke rateshard clinical
Main Result
Effect estimate: HR 0.68 (95% CI 0.37-1.26)
p-value: p=0.22
Routine anticoagulation with warfarin for up to 90 days after an anterior myocardial infarction does not significantly reduce the risk of ischemic stroke in elderly patients.
Limitations
- Retrospective population-based cohort analysis with inherent survival bias and lack of randomization
- Elderly cohort of anterior MI patients may not represent the general post-MI population
- Reliance on administrative data limited clinical information such as left ventricular ejection fraction
- Inability to ascertain out-of-hospital events like atrial fibrillation or stroke that did not require hospitalization
- Inability to ascertain the appropriateness of warfarin therapy, intensity of anticoagulation, or patient compliance
Cite This Study
Udell et al. (2010) conducted a cohort in Acute myocardial infarction (n=10,383). Warfarin vs. No warfarin was evaluated on Four-year ischemic stroke (HR 0.68, 95% CI 0.37-1.26, p=0.22). Among elderly patients who survived an anterior myocardial infarction, the use of warfarin for up to 90 days post-discharge did not significantly reduce the risk of ischemic stroke (HR 0.68).
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