Warfarin in the Prevention of Stroke Associated with Nonrheumatic Atrial Fibrillation

Ezekowitz, Michael D.; Bridgers, Samuel L.; James, Kenneth E.; Carliner, Nathan H.; Colling, Cindy; Gornick, Charles C.; Krause‐Steinrauf, Heidi; Kurtzke, John F.; Nazarian, Sarkis M.; Radford, Martha J.; Rickles, Frederick R.; Shabetai, Ralph; Deykin, Daniel

doi:10.1056/nejm199211123272002

Cited by 1,183 publications

(298 citation statements)

References 17 publications

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“…[1][2][3][4][8][9][10][11] Warfarin decreases the risk of stroke by 64% to 86% compared with placebo. [12][13][14][15][16] Warfarin has also been associated with decreased total health care costs among patients with AF in comparison with patients who were not taking warfarin. 17 However, despite its many benefits, warfarin is associated with adverse events, particularly bleeding and its resulting costs, which likely play a substantive role in warfarin nonpersistence (i.e., discontinuation or interruption).…”

Section: ■■ Methods Study Designmentioning

confidence: 99%

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

Spivey

Qiao

Liu

et al. 2015

JMCP

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Section: ■■ Methods Study Designmentioning

confidence: 99%

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

Spivey

Qiao

Liu

et al. 2015

JMCP

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“…We chose the meta-analysis by Hart et al,136 as it is the most recent and comprehensive. Hart et al 136 identified six studies [137][138][139][140][141][142] comparing warfarin to either 'control' or placebo, from which we extracted evidence on stroke, bleeds, ICH, death, SE and TIA, summarised in Table 60. The Boston Area Anticoagulation Trial for Atrial Fibrillation (BAATAF) study 139 used patients on no treatment but with the option of aspirin as the control; this study was omitted in a sensitivity analysis.…”

Section: Relative Treatment Efficacymentioning

confidence: 99%

Oral anticoagulants for primary prevention, treatment and secondary prevention of venous thromboembolic disease, and for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis and cost-effectiveness analysis

Sterne

Bodalia

Bryden

et al. 2017

Health Technol Assess

131

175

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outside the submitted work, and AntiCoagulation Europe (ACE), a registered charity, the aims of which include raising awareness of the risk and prevention of thrombosis, and providing information, education and support to people who are on anticoagulation therapy for any duration, including long term for those with chronic conditions. Diane Eaton works with ACE in an associate consultant capacity in the role of Project Development Manager. She has over 40 years of personal experience of anticoagulation therapy and represents ACE as a patient expert at the National Institute for Health and Care Excellence (NICE). On behalf of the charity, she has provided the patient perspective for the submissions for the technology appraisals for the novel oral anticoagulants (NOACs) and Diagnostic Guidance for Coagulometers over a 4-year period. Please note that the financial information has been prepared by Eve Knight, Chief Executive of AntiCoagulation Europe, for the purpose of inclusion in this document. Published March 2017 DOI: 10.3310/hta21090This report should be referenced as follows:Sterne JAC, Bodalia PN, Bryden PA, Davies PA, López-López JA, Okoli GN, et al. Oral anticoagulants for primary prevention, treatment and secondary prevention of venous thromboembolic disease, and for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis and cost-effectiveness analysis. Health Technol Assess 2017;21(9). Reports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. Health Technology Assessment is indexed and abstracted inReviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 11/92/17. The contractual start date was in October 2013. The draft report began editorial review in May 2015 and was accepted for publication in...

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“…However, warfarin was prescribed to replace aspirin as it is more benefitted to patient with stroke risk score more than 2 and could reduce the risk of stroke by two-thirds and mortality by one-quarter compared to aspirin use. [19][20][21][22][23] Subsequent doses of warfarin dependent on the prothrombin time, reported as INR (international normalised ratio). Hence, regular testing of the INR in first three months of treatment is essential for patient who never received warfarin.…”

Section: Discussionmentioning

confidence: 99%

Management of Thyrotoxicosis with Atrial Fibrillation- A Case Report

Senthilnathan¹,

Mey²

2017

JYP

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Background: Thyrotoxicosis is a condition occurs when excessive thyroid hormone level produced by overactive thyroid gland. It is the risk factor of getting atrial fibrillation (AF) as it could exert marked influences on electrical impulse generation and conduction which associated with shortening of action potential duration and contribute to AF. Case: A 57 years old Chinese female was diagnosed with thyrotoxicosis and atrial fibrillation when she was admitted to emergency department of hospital with complaints of shortness of breath, dyskinesia, on and off palpitation, fine tremor, tachycardia, warm skin, firm, enlarged and palpable thyroid, having patches of vitiligo on hands and feet and increase bowel movement. The CT scan has revealed small infarct near left band ganglia. Aims: The aims of management in this case were to resolve the symptoms presented and get the thyroid hormone levels restored to euthyroid state. Results: Aspirin and propranolol were given immediately after diagnosis for symptomatic relieve and rate control. Carbimazole and dexa methasone were given concurrently for hyperthyroid management. Aspirin was then replaced by warfarin before patient discharged to have better control and reduce risk of stroke. Furthermore, the patient's ECG and INR were monitored closely for stroke prevention.

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Warfarin in the Prevention of Stroke Associated with Nonrheumatic Atrial Fibrillation

Abstract: Low-intensity anticoagulation with warfarin prevented cerebral infarction in patients with nonrheumatic atrial fibrillation without producing an excess risk of major hemorrhage. This benefit extended to patients over 70 years of age.

Cited by 1,183 publications

References 17 publications

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

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

Oral anticoagulants for primary prevention, treatment and secondary prevention of venous thromboembolic disease, and for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis and cost-effectiveness analysis

Management of Thyrotoxicosis with Atrial Fibrillation- A Case Report

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