Warfarin Use and Stroke Risk Among Patients With Nonvalvular Atrial Fibrillation in a Large Managed Care Population

Deitelzweig, Steven; Buysman, Erin; Pinsky, Brett; Lacey, Michael J.; Jing, Yonghua; Wiederkehr, Daniel; Graham, John

doi:10.1016/j.clinthera.2013.06.005

Cited by 37 publications

(34 citation statements)

References 25 publications

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“…26 Likewise, Deitelzweig et al found increased stroke risk during periods of warfarin discontinuation among patients with NVAF. 36 This study suggested that history of stroke/TIA served as a protective factor against discontinuation/interruption. Similarly, in the Kaplan-Meier analysis, patients with higher CHADS 2 scores (an indicator of increased stroke risk) had longer time to first incident of warfarin discontinuation/interruption compared with patients who had lower scores.…”

Section: Analyses Of Clinical Factors Associated With Interruption Anmentioning

confidence: 81%

“…For example, Song et al (2012) found that 42.6% of AF patients discontinued warfarin (with a gap of at least 90 days between warfarin prescriptions) within the first year of use. 24 Deitelzweig et al (2013) found that 51.4% of NVAF patients discontinued warfarin therapy (with a gap over 60 days between warfarin prescriptions) at least once during follow-up (the mean duration of follow-up was 668 days). 36 However, in a study of long-term care patients, Patel et al found a 1-year discontinuation rate (with a gap over 37 days between warfarin prescriptions) of 65%.…”

Section: Analyses Of Clinical Factors Associated With Interruption Anmentioning

confidence: 99%

“…24 Deitelzweig et al (2013) found that 51.4% of NVAF patients discontinued warfarin therapy (with a gap over 60 days between warfarin prescriptions) at least once during follow-up (the mean duration of follow-up was 668 days). 36 However, in a study of long-term care patients, Patel et al found a 1-year discontinuation rate (with a gap over 37 days between warfarin prescriptions) of 65%. 25 Likewise, the interruption rate in this study was much lower than the rate suggested by the Raunsø et al study (2012) using the Danish National Patient Registry.…”

Section: Analyses Of Clinical Factors Associated With Interruption Anmentioning

confidence: 99%

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

Spivey

Qiao

Liu

et al. 2015

JMCP

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Section: Analyses Of Clinical Factors Associated With Interruption Anmentioning

confidence: 81%

Section: Analyses Of Clinical Factors Associated With Interruption Anmentioning

confidence: 99%

Section: Analyses Of Clinical Factors Associated With Interruption Anmentioning

confidence: 99%

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

Spivey

Qiao

Liu

et al. 2015

JMCP

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“…17 As the underuse and discontinuation of warfarin therapy are high, especially among elderly NVAF patients, it will be important to re-evaluate treatment patterns of anticoagulation therapy in the near future, since the choices of oral anticoagulants for treatment of NVAF patients have increased with the introduction of dabigatran, rivaroxaban, and apixaban to the market. 8,9,16 greater stroke risk than NVAF patients without dyspepsia. 6 In addition, we found that NVAF patients with dyspepsia were 5 times more likely to be hospitalized for a GI bleed than NVAF patients who did not have dyspepsia.…”

Section: Tablementioning

confidence: 99%

“…15 Moreover, a recent study, also conducted on a large managed care population, found that 51.4% of NVAF patients who initiated warfarin therapy discontinued the therapy, and during discontinuation periods, stroke risk increased 1.60-fold compared with therapy periods. 16 Based on clinical trial data, the stroke risk of NVAF patients treated with rivaroxaban who discontinue treatment is also elevated after temporarily or permanently discontinuing anticoagulation therapy. 17 As the underuse and discontinuation of warfarin therapy are high, especially among elderly NVAF patients, it will be important to re-evaluate treatment patterns of anticoagulation therapy in the near future, since the choices of oral anticoagulants for treatment of NVAF patients have increased with the introduction of dabigatran, rivaroxaban, and apixaban to the market.…”

Section: Tablementioning

confidence: 99%

Health Care Burden of Dyspepsia Among Nonvalvular Atrial Fibrillation Patients

Kim

Bell

Makenbaeva

et al. 2014

JMCP

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A trial fibrillation (AF) is the most common cardiac arrhythmic disorder in the United States and is estimated to affect approximately 1% of adult Americans, of which the majority (~85%) are 65 years of age and older. 1,2 With the growing elderly population in the United States, the prevalence of AF is expected to more than double by 2050. 1,2People with AF have up to a 5-fold increased risk of stroke, with stroke risk being highest for persons between the ages of 80 and 89.3 Another common condition more frequent in persons older than 65 years of age is dyspepsia, a gastrointestinal (GI) disorder widely defined by symptoms of postprandial fullness, early satiation, and epigastric pain, or discomfort or burning in the absence of causative structural disease. 4 A review of several U.S. studies reported that the pooled prevalence of dyspeptic, gastroesophageal, and dyspeptic and/or gastroesophageal symptoms was 16.3% among the general U.S. population. Patients with 1 inpatient or 2 outpatient dyspepsia diagnoses within 12 months following any NVAF diagnosis were grouped into the dyspeptic cohort, and patients without any dyspepsia diagnosis were grouped into the nondyspeptic cohort. Of the overall cohorts, patients were matched by key patient characteristics. Dyspepsia was further categorized as having a prior history of dyspepsia (chronic) or no dyspepsia (nonchronic) during the baseline period. Health care resource utilization, associated costs, and warfarin use were evaluated during a 12-month follow-up period.RESULTS: Of NVAF patients included in the study (N = 142,322), 10.4% were diagnosed with dyspepsia. After matching for key characteristics, NVAF patients with dyspepsia had significantly greater inpatient, outpatient, and prescription claims per patient year than those without dyspepsia (1.24 ± 1.21 vs. 0.36±0.68, P < 0.0001; 110.18 ± 101.03 vs. 66.98 ± 72.43, P < 0.0001; and 52.13 ± 35.30 vs. 44.29 ± 32.41, P < 0.0001, respectively).

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Antithrombotics prescription and adherence among stroke survivors: A systematic review and meta‐analysis

et al. 2022

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Objectives We aimed to investigate the prescription of antithrombotic drugs (including anticoagulants and antiplatelets) and medication adherence after stroke. Methods We performed a systematic literature search across MEDLINE and Embase, from January 1, 2015, to February 17, 2022, to identify studies reporting antithrombotic medications (anticoagulants and antiplatelets) post stroke. Two people independently identified reports to include, extracted data, and assessed the quality of included studies according to the Newcastle–Ottawa scale. Where possible, data were pooled using random‐effects meta‐analysis. Results We included 453,625 stroke patients from 46 studies. The pooled proportion of prescribed antiplatelets and anticoagulants among patients with atrial fibrillation (AF) was 62% (95% CI: 57%–68%), and 68% (95% CI: 58%–79%), respectively. The pooled proportion of patients who were treated according to the recommendation of guidelines of antithrombotic medications from four studies was 67% (95% CI: 41%–93%). It was reported that 11% (95% CI: 2%–19%) of patients did not receive antithrombotic medications. Good adherence to antiplatelet, anticoagulant, and antithrombotic medications was 78% (95% CI: 67%–89%), 71% (95% CI: 57%–84%), and 73% (95% CI: 59%–86%), respectively. Conclusion In conclusion, we found that less than 70% of patients were prescribed and treated according to the recommended guidelines of antithrombotic medications, and good adherence to antithrombotic medications is only 73%. Prescription rate and good adherence to antithrombotic medications still need to be improved among stroke survivors.

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Warfarin Use and Stroke Risk Among Patients With Nonvalvular Atrial Fibrillation in a Large Managed Care Population

Cited by 37 publications

References 25 publications

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

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

Health Care Burden of Dyspepsia Among Nonvalvular Atrial Fibrillation Patients

Antithrombotics prescription and adherence among stroke survivors: A systematic review and meta‐analysis

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