Outcomes of Long-Term Anticoagulation in Frail Elderly Patients with Atrial Fibrillation

Anticoagulation Therapy for Stroke Prevention in Atrial Fibrillation

“…Previous studies of antithrombotic therapy in atrial fibrillation outside of trials have primarily studied selected patient populations (eg, hospitalized or nursing home patients with atrial fibrillation), involved relatively modest sample sizes, had small numbers of outcome events leading to less precise estimates of effect, or other methodological limitations. [12][13][14][16][17][18][38][39][40] Our results materially extend these prior findings by providing contemporary and precise estimates of thrombo- *In the CHADS2 scoring system, 2 points are given for prior thromboembolism, and 1 point each for congestive heart failure, diagnosed hypertension, age 75 years or older, and diabetes mellitus. Number of patients represent those with that baseline score.…”

“…Previous studies of thromboembolic and hemorrhagic outcomes of antithrombotic therapy for patients with atrial fibrillation treated in clinical practice settings have been relatively small, limited in clinical detail, or lacked information on longitudinal exposure to anticoagulation. [11][12][13][14][15][16][17][18] As a result, it remains unclear how well randomized trials of anticoagulation apply to the broader spectrum of patients with atrial fibrillation in typical clinical settings. To address these issues, we systematically examined the effects of warfarin therapy on the risk of ischemic stroke and other systemic thromboembolism, intracranial and other hemorrhage, and all-cause mortality focusing specifically on follow-up of 11526 adults with nonvalvular atrial fibrillation who did not have contraindications to warfarin therapy at study entry within the Anticoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study 19 cohort (N=13559).…”

Are the Results of Randomized Controlled Trials on Anticoagulation in Patients With Atrial Fibrillation Generalizable to Clinical Practice?

“…Articles were assessed independently by each of us for various variables, including type of study, patient numbers, demographics, warfarin exposure, mortality, stroke incidence, bleeding complications, and anticoagulation control. We agreed on the inclusion of 6 articles, [18][19][20][21][22][23] which gave information on at least 7 of the variables previously mentioned for further joint review. Following the review, 2 studies 21,22 were excluded because they reported results from all patients undergoing anticoagulation (those with deep vein thromboses, pulmonary embolism, and prosthetic valves) and it was not possible to obtain data on the subgroup with atrial fibrillation alone.…”

“…Following the review, 2 studies 21,22 were excluded because they reported results from all patients undergoing anticoagulation (those with deep vein thromboses, pulmonary embolism, and prosthetic valves) and it was not possible to obtain data on the subgroup with atrial fibrillation alone. One study 23 (a retrospective study of elderly nursing home residents) was not included in the analyses, because all patients were in institutional care and were not representative of mainstream practice. Only 3 studies 18-20 met all the predefined criteria for inclusion in the review.…”

Antithrombotic Therapy in Atrial Fibrillation

“…30 -32 Studies of the outcomes of antithrombotic therapy in patients with AF in nontrial clinical settings have often involved hospitalized patients or other selected populations (eg, patients in nursing homes), were limited by relatively small patient samples, and accumulated relatively few thromboembolic and hem-orrhagic outcome events leading to imprecise estimates of event rates. [92][93][94][95][96][97][98] Among survivors of ischemic stroke with AF, warfarin was more effective than aspirin for reducing recurrent stroke, and recurrent stroke rates were lower during periods on vs off warfarin. 99,100 In two studies of hospitalized patients with nonvalvular AF, the risk of stroke or transient ischemic attack was lower in patients discharged on warfarin than in those given no antithrombotic therapy (adjusted relative risks 0.76 and 0.31) and thromboembolic rates were lower with warfarin than aspirin.…”