The Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation
Why the study?
Does warfarin therapy improve net clinical benefit in adults with nonvalvular atrial fibrillation?
Population
13,559 adults with nonvalvular atrial fibrillation
Comparison
Warfarin therapy vs No warfarin therapy (untreated)
Design
Cohort
Follow-up
More than 66,000 person-years of follow-up
Authors
Discussion
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Member takes
Overview
Supports net benefit of warfarin in high-risk nonvalvular AF; extends observational data but leaves open need for randomized confirmation.
Structured PICO
Does warfarin therapy improve net clinical benefit in adults with nonvalvular atrial fibrillation?
P
Population
13,559 adults with nonvalvular atrial fibrillation
I
Intervention
Warfarin therapy
C
Comparator
No warfarin therapy (untreated)
O
Outcome
Net clinical benefit (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 of 1.5)composite
Warfarin provides a positive net clinical benefit in patients with nonvalvular atrial fibrillation, with the greatest benefit observed in those at the highest untreated risk for stroke, including the very elderly and those with prior stroke.
Limitations
- Residual confounding is a possibility
- Some outcome events were probably missed by the screening algorithm or when medical records were unavailable
Cite This Study
Daniel E. Singer (2009) studied this question.