Discontinuation/Interruption of Warfarin Therapy in Patients with Nonvalvular Atrial Fibrillation

Spivey, Christina A.; Qiao, Yanru; Liu, Xianchen; Mardekian, Jack; Parker, Robert B.; Phatak, Hemant; Claflin, A.B.; Kachroo, Sumesh; Abdulsattar, Younos; Chakrabarti, Anwesa; Wang, Junling

doi:10.18553/jmcp.2015.21.7.596

Cited by 24 publications

(31 citation statements)

References 40 publications

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“…This prospective study of patients on dabigatran showed the probability of persistence over 2 years exceeded 70%, which is higher than previously reported persistence rates to warfarin 3,4 and claims-based estimates of persistence to NOACs. 8,10 Furthermore, it was also shown that the greatest risk for discontinuation is in the early period following treatment initiation.…”

Section: Discussioncontrasting

confidence: 82%

Dabigatran Persistence and Outcomes Following Discontinuation in Atrial Fibrillation Patients from the GLORIA-AF Registry

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et al. 2020

The American Journal of Cardiology

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The study was designed under the clinical expert guidance of an executive steering committee composed of representatives from the international academic scientific and medical communities, as well as from the Sponsor Company. Members from the Sponsor Company did not have voting privileges. Data were collected independently by participating clinical sites on a secure webbased server and the Sponsor was not involved in data collection. Analysis was performed by the Sponsor who contributed to writing the report and in the decision to submit the manuscript for publication. This work is intended to form part of the requirements to fulfill a PhD thesis for author MP. See page 390 for disclosure information.

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Section: Discussioncontrasting

confidence: 82%

Dabigatran Persistence and Outcomes Following Discontinuation in Atrial Fibrillation Patients from the GLORIA-AF Registry

Paquette

França

Teutsch

et al. 2020

The American Journal of Cardiology

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“…29 The discontinuation of OA for patients with NVAF has not improved with the new direct-acting OA, 30 and has been associated with younger age, anemia, bleeding, frailty, low life expectancy, hospitalizations and emergency department visits. 22 In the present study, OA was discontinued for one of every four patients. The discontinuation was associated with the risk of hemorrhage, and the absence of ischemic heart disease.…”

Section: Discussionmentioning

confidence: 92%

“…In a survey of cardiologists, geriatricians and primary care physicians, both conditions were frequently mentioned for not starting OA therapy . In another study with the American MarketScan Database, both anemia and bleeding were associated with treatment discontinuation . Patients have a different perception of risks than physicians .…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with discontinuing or not starting oral anticoagulant therapy in older hospitalized patients with non‐valvular atrial fibrillation

Díez-Manglano

Mostaza²,

Pose

et al. 2018

Geriatrics Gerontology Int

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“…During 12 months after warfarin initiation, 12% had interruption without discontinuation, and 43% had discontinuation among a total of 58,593 patients with non-valvular atrial fibrillation [1] . The risk of an ischemic stroke is almost 60% greater during warfarin discontinuation for any reason in patients with atrial fibrillation [2] .…”

Section: Introductionmentioning

confidence: 99%

Risk of Ischemic Stroke in High Risk Atrial Fibrillation Patients during Periods of Warfarin Discontinuation for Surgical Procedures

et al. 2016

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Importance: The risk of ischemic stroke during periods of warfarin discontinuation for surgical procedures is recognized but not well characterized. Objective: The study aimed to quantitate the risk of ischemic stroke associated with high risk atrial fibrillation during periods of warfarin discontinuation. Design, Setting and Participants: A cohort of 4,060 patients (mean follow-up period of 3.5 ± 1.3 years) were randomized into the Atrial Fibrillation Follow-Up Investigation of Rhythm Management study. Patients enrolled in the study had atrial fibrillation plus at least one other risk factor for stroke or death: age ≥65 years', systemic hypertension, diabetes mellitus, congestive heart failure, transient ischemic attack, prior stroke, left atrium >50 mm, left ventricular fractional shortening <25% or left ventricular ejection fraction <40%. Exposure: Warfarin discontinuation for procedure. Main Outcome and Measures: The association of warfarin discontinuation with the incidence of ischemic stroke using pooled repeated measures and Cox proportional hazards analyses during follow-up after adjusting for age, gender, obesity, diabetes mellitus, hypercholesterolemia, cigarette smoking and study period. Results: Warfarin discontinuation for procedure occurred in 265 (0.4%) of the 71,355 person observations. Compared with those without warfarin discontinuation, the rate of ischemic stroke was higher among participants with surgery-related warfarin discontinuation (1.1% of 265 person observations vs. 0.2% of 71,090 person observations, p = 0.001). Warfarin discontinuation was associated with an increased risk for ischemic stroke (relative risk 5.8; 95% CI 1.8-18.4) after adjusting for potential confounders. The population-attributable risk associated with surgery-related warfarin discontinuation was estimated to be 23.1% (95% CI 15.2-30.9%) for ischemic stroke. Conclusions and Relevance: The 6-fold higher risk of ischemic stroke associated with discontinuation of warfarin for surgical procedures must be recognized in high risk atrial fibrillation patients and considered in the risk-benefit analysis of any procedure.

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Discontinuation/Interruption of Warfarin Therapy in Patients with Nonvalvular Atrial Fibrillation

Cited by 24 publications

References 40 publications

Dabigatran Persistence and Outcomes Following Discontinuation in Atrial Fibrillation Patients from the GLORIA-AF Registry

Dabigatran Persistence and Outcomes Following Discontinuation in Atrial Fibrillation Patients from the GLORIA-AF Registry

Factors associated with discontinuing or not starting oral anticoagulant therapy in older hospitalized patients with non‐valvular atrial fibrillation

Risk of Ischemic Stroke in High Risk Atrial Fibrillation Patients during Periods of Warfarin Discontinuation for Surgical Procedures

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