Relationship of Age With Stroke and Death in Anticoagulated Patients With Nonvalvular Atrial Fibrillation

Senoo, Keitaro; Lip, Gregory Y. H.

doi:10.1161/strokeaha.115.010614

Cited by 14 publications

(11 citation statements)

References 25 publications

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“…European Stroke Organisation (ESO) guidelines do not specifically contraindicate the use of OACs in patients with dementia, but do not recommend their use in patients with comorbid conditions such as falls or poor compliance . However, studies that investigated the use of warfarin for prevention of thromboembolism in AF in different age groups have shown a higher rate of bleeding in the older population, but also a higher rate of IS which would indicate a greater need for anticoagulation (Table ) . However, older patients (>75/80 years) in these studies are significantly under‐represented.…”

Section: Management Of Acute Ischaemic Strokementioning

confidence: 95%

Management of acute ischaemic stroke in patients with dementia

et al. 2017

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Section: Management Of Acute Ischaemic Strokementioning

confidence: 95%

Management of acute ischaemic stroke in patients with dementia

et al. 2017

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“…A generally accepted quality measure in warfarin therapy is the time patients spend within the therapeutic range (percent time in therapeutic range; TTR)[ 3 , 4 ]. An inverse correlation between TTR and hemorrhagic and thromboembolic complications has been established and it has been suggested that the benefits of warfarin therapy may be outweighed if the quality of warfarin therapy is too poor[ 5 – 8 ]. In continuation hereof, it may be beneficial to increase TTR, if possible, as it would decrease the risk of therapy-related complications.…”

Section: Introductionmentioning

confidence: 99%

The importance of mean time in therapeutic range for complication rates in warfarin therapy of patients with atrial fibrillation: A systematic review and meta-regression analysis

et al. 2017

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Background\Anticoagulation is used for stroke prophylaxis in non-valvular atrial fibrillation, amongst other by use of the vitamin K antagonist, warfarin. Quality in warfarin therapy is often summarized by the time patients spend within the therapeutic range (percent time in therapeutic range, TTR). The correlation between TTR and the occurrence of complications during warfarin therapy has been established, but the influence of patient characteristics in that respect remains undetermined. The objective of the present papers was to examine the association between mean TTR and complication rates with adjustment for differences in relevant patient cohort characteristics.MethodsA systematic literature search was conducted in MEDLINE and Embase (2005–2015) to identify eligible studies reporting on use of warfarin therapy by patients with non-valvular atrial fibrillation and the occurrence of hemorrhage and thromboembolism. Both randomized controlled trials and observational cohort studies were included. The association between the reported mean TTR and major bleeding and stroke/systemic embolism was analyzed by random-effects meta-regression with and without adjustment for relevant clinical cohort characteristics. In the adjusted meta-regressions, the impact of mean TTR on the occurrence of hemorrhage was adjusted for the mean age and the proportion of populations with prior stroke or transient ischemic attack. In the adjusted analyses on thromboembolism, the proportion of females was, furthermore, included.ResultsOf 2169 papers, 35 papers met pre-specified inclusion criteria, holding relevant information on 31 patient cohorts. In univariable meta-regression, increasing mean TTR was significantly associated with a decreased rate of both major bleeding and stroke/systemic embolism. However, after adjustment mean TTR was no longer significantly associated with stroke/systemic embolism. The proportion of residual variance composed by between-study heterogeneity was substantial for all analyses.ConclusionsAlthough higher mean TTR in warfarin therapy was associated with lower complication rates in atrial fibrillation, the strength of the association was decreased when adjusting for differences in relevant clinical characteristics of the patient cohorts. This study suggests that mainly the safety of warfarin therapy increases with higher mean TTR, whereas effectiveness appears not to be substantially improved.Due to the limitations immanent in the meta-regression methods, the results of the present study should be interpreted with caution. Further research on the association between the quality of warfarin therapy and risk of complications is warranted with adjustment for clinically relevant characteristics.

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“…In the present community-based study, OAC therapy was still underused (<60%) in both Japanese and British elderly populations. The risks are probably multifactorial, perhaps reflecting a perception that elderly patients with AF carry a relatively higher risk of major bleeding, but the relative benefits/harms of OAC for stroke or mortality and major bleeding showed consistency despite increasing age strata in a real-world and clinical trial setting 12 13…”

Section: Discussionmentioning

confidence: 99%