Warfarin related to low rate of residual stroke in patients with atrial fibrillation
A review of clinical trials comparing warfarin with other medications for stroke prevention suggests that warfarin was associated with a low risk of stroke or non-central nervous system embolism in patients with nonvalvular atrial fibrillation (rapid, irregular heart beat), according to a study published Online First by Archives of Internal Medicine.
Novel (new) antithrombotic medications (which interfere with blood clots) have been developed as alternatives to warfarin and clinical trials have suggested that some are superior, easier to administer and lack interaction with other medications and food, the authors write in their study background. However, the use of these new medications may be hampered by cost, so the authors comment that they expect warfarin treatment to continue as the dominant therapy for patients with atrial fibrillation (AF) despite some inadequacies and the need for close laboratory supervision.
Shikhar Agarwal, M.D., M.P.H., C.P.H., and colleagues with the Cleveland Clinic, Ohio, searched the medical literature and compiled eight randomized controlled trials with 32,053 patients for their meta-analysis comparing warfarin with other medications.
The authors report that the pooled annual incidence rate of stroke or non-CNS (central nervous system) embolism was estimated to be 1.66 percent, which was lower than the 2.09 percent in a previous meta-analysis.
The risk of stroke was higher in elderly patients, women, patients who had had a previous stroke or TIA (transient ischemic attack or mini-stroke) and those patients reporting no previous exposure to vitamin K antagonists, the review indicated.
"Thus, despite the development of newer antithrombotic agents with increased ease of administration that are superior or noninferior to warfarin, most patients with nonvalvular AF will probably continue to be treated with warfarin in the near future owing to cost considerations," the authors comment. "Indeed, warfarin will likely continue to be widely used as the drug of choice in several countries around the world."
In an invited commentary, Daniel E. Singer, M.D., of Massachusetts General Hospital, Boston, and Alan S. Go, M.D., of Kaiser Permanente Northern California, Oakland, write: "It is beyond the scope of this commentary to provide detailed guidance as to which patients with AF should be taking a novel agent. However, patients who are comfortable with warfarin therapy and whose TTR (time in the standard therapeutic range) is above 75 percent should be in no hurry to switch. They may forgo a small reduction in risk of intracranial hemorrhage, but they should benefit as we gain more experience with the novel agents."
"We have begun a new, very promising era in preventing stroke in AF. The novel anticoagulants appear to constitute a positive disruptive technology. However, warfarin management has also evolved, allowing safe, effective and inexpensive anticoagulation for many patients with AF, likely slowing the ultimate transition to modern anticoagulant agents," they conclude.
Journal reference: JAMA Internal Medicine
Provided by JAMA and Archives Journals
- Rivaroxaban has less risk of brain bleeding in patients at high risk for stroke Feb 02, 2012 | not rated yet | 0
- New assessment quantifies risks and benefits of warfarin treatment for atrial fibrillation Aug 31, 2009 | not rated yet | 0
- More advantages found for new drug: study Feb 10, 2011 | not rated yet | 0
- Dabigatran associated with increased risk of acute coronary events Jan 09, 2012 | not rated yet | 0
- Apixaban superior to warfarin for preventing stroke, reducing bleeding and saving lives Aug 28, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
The idea behind a reverse shock
49 minutes ago So in a supernova explosion for example (5th slide) http://www.astro.princeton.edu/~burrows/classes/541/blastwavesChisari.pdf Ambient medium is...
Guass's Law for a charge distribution
1 hour ago First, this is not a homework question, just something I've been confused about for some time. I understand how to use Guass's law in many ways but...
1 hour ago Hello :) i'm new to this forum, so excuse me for my straightforwardness ;) I'm working on my bachelor work and i can't find a solution. I'm writing...
siphon and bernouli theorum
3 hours ago 1. I found this diagram on book but there weren't any description.can someone tell me, what its trying to tell specially by those two red lines...
Hot gas expansion rate into outer space
3 hours ago Good Morning Sirs, it seems to be surprisingly hard to get the numbers of a mystery: How fast expand hot rocket exhaust gases into empty space? ...
Magnetic field lines through copper
8 hours ago Hello. Assume an electron gun, as in CRT, made of plumbing copper instead of glass. Using magnetic scanning coils to move electron beam. Will the...
- More from Physics Forums - Classical Physics
More news stories
Heart failure accelerates the aging process and brings on early andropausal syndrome (AS), according to research presented today at the Heart Failure Congress 2013. AS, also referred to as male 'menopause', was four times ...
Cardiology 6 hours ago | not rated yet | 1
Mortality and length of stay are highest in heart failure patients admitted in January, on Friday, and overnight, according to research presented today at the Heart Failure Congress 2013. The analysis of nearly 1 million ...
Cardiology 6 hours ago | not rated yet | 0
Coenzyme Q10 decreases all cause mortality by half, according to the results of a multicentre randomised double blind trial presented today at Heart Failure 2013 congress. It is the first drug to improve heart failure mortality ...
Cardiology 6 hours ago | 5 / 5 (2) | 4
Transcatheter aortic valve implantation (TAVI) is effective and safe in Asian patients, according to early experience based on first results from a multicentre Asian registry reported at EuroPCR 2013.
Cardiology May 24, 2013 | not rated yet | 0
Routinely measuring fractional flow reserve (FFR) using pressure wire assessment during coronary angiography for diagnosis of chest pain leads to significant changes in the management of one in four patients, according to ...
Cardiology May 24, 2013 | not rated yet | 0
(AP)—Department of Justice lawyers have again asked a federal appeals court in New York to delay lifting age restrictions and prescription requirements on an emergency contraceptive popularly known as the morning-after ...
6 hours ago | not rated yet | 0
Two mutations central to the development of infantile myofibromatosis (IM)—a disorder characterized by multiple tumors involving the skin, bone, and soft tissue—may provide new therapeutic targets, according to researchers ...
23 hours ago | 3 / 5 (2) | 0 |
Talking on a hands-free device while behind the wheel can lead to a sharp increase in errors that could imperil other drivers on the road, according to new research from the University of Alberta.
22 hours ago | not rated yet | 0
Kate O'Reilly's spring allergy survival kit includes the usual stuff - nasal sprays, allergy pills and a box of tissues. This season, she's added a new weapon to her line of defense: an app on her smartphone.
23 hours ago | not rated yet | 0
(Medical Xpress)—A research team, led by Jeremy Barr, a biology post-doctoral fellow, unveils a new immune system that protects humans and animals from infection.
May 20, 2013 | 4.8 / 5 (30) | 9 |
Women at a particular stage in their monthly menstrual cycle may be more vulnerable to some of the psychological side-effects associated with stressful experiences, according to a study from UCL.
May 24, 2013 | 4 / 5 (4) | 4 |