BACKGROUND: Stroke prevention is a goal of atrial fibrillation (AF) management, but discontinuation of warfarin anticoagulation therapy is common. OBJECTIVE: To investigate the association between warfarin discontinuation and hospitalization for stroke among nonvalvular AF (NVAF) patients enrolled in managed care. METHODS: Patients with NVAF who initiated warfarin therapy from January 2005 through June 2009 were included. Warfarin discontinuation was defined as a supply gap >60 days without evidence of International Normalized Ratio measurements. Follow-up, which was a variable time period from warfarin initiation until the earlier of death, disenrollment from the health plan, or June 30, 2010, was divided into periods of warfarin treatment and discontinuation. Stroke events were identified based on claims for inpatient stays with a primary diagnosis of stroke or transient ischemic attack. Cox proportional hazards models were constructed to assess the relationship between warfarin discontinuation and incident stroke while adjusting for baseline demographics, stroke and bleeding risk, and comorbidities, as well as time-dependent antiplatelet use, stroke, and bleeding events in the previous warfarin treatment period. RESULTS: Among warfarin initiators with NVAF (N = 16,253), 51.4% discontinued warfarin therapy at least once during a mean follow-up of 668 days. Stroke risk was significantly greater during warfarin discontinuation periods compared with therapy periods (hazard ratio = 1.60; 95% CI, 1.35-1.90; P < 0.001). CONCLUSIONS: More than half of patients on warfarin had treatment gaps or discontinued therapy. Therapy gaps were associated with increased stroke risk.
BACKGROUND:Stroke prevention is a goal of atrial fibrillation (AF) management, but discontinuation of warfarin anticoagulation therapy is common. OBJECTIVE: To investigate the association between warfarin discontinuation and hospitalization for stroke among nonvalvular AF (NVAF) patients enrolled in managed care. METHODS:Patients with NVAF who initiated warfarin therapy from January 2005 through June 2009 were included. Warfarin discontinuation was defined as a supply gap >60 days without evidence of International Normalized Ratio measurements. Follow-up, which was a variable time period from warfarin initiation until the earlier of death, disenrollment from the health plan, or June 30, 2010, was divided into periods of warfarin treatment and discontinuation. Stroke events were identified based on claims for inpatient stays with a primary diagnosis of stroke or transient ischemic attack. Cox proportional hazards models were constructed to assess the relationship between warfarin discontinuation and incident stroke while adjusting for baseline demographics, stroke and bleeding risk, and comorbidities, as well as time-dependent antiplatelet use, stroke, and bleeding events in the previous warfarin treatment period. RESULTS: Among warfarin initiators with NVAF (N = 16,253), 51.4% discontinued warfarin therapy at least once during a mean follow-up of 668 days. Stroke risk was significantly greater during warfarin discontinuation periods compared with therapy periods (hazard ratio = 1.60; 95% CI, 1.35-1.90; P < 0.001). CONCLUSIONS: More than half of patients on warfarin had treatment gaps or discontinued therapy. Therapy gaps were associated with increased stroke risk.
Authors: G Sanfélix-Gimeno; C L Rodríguez-Bernal; I Hurtado; C Baixáuli-Pérez; J Librero; S Peiró Journal: BMJ Open Date: 2015-10-19 Impact factor: 2.692
Authors: Stephanie R Reading; Mary Helen Black; Daniel E Singer; Alan S Go; Margaret C Fang; Natalia Udaltsova; Teresa N Harrison; Rong X Wei; In-Lu Amy Liu; Kristi Reynolds Journal: BMC Cardiovasc Disord Date: 2019-02-11 Impact factor: 2.298
Authors: Gordon Chu; Jaap Seelig; Emmy M Trinks-Roerdink; Anouk P van Alem; Marco Alings; Bart van den Bemt; Lucas Va Boersma; Marc A Brouwer; Suzanne C Cannegieter; Hugo Ten Cate; Charles Jhj Kirchhof; Harry Jgm Crijns; Ewoud J van Dijk; Arif Elvan; Isabelle C van Gelder; Joris R de Groot; Frank R den Hartog; Jonas Ssg de Jong; Sylvie de Jong; Frederikus A Klok; Timo Lenderink; Justin G Luermans; Joan G Meeder; Ron Pisters; Peter Polak; Michiel Rienstra; Frans Smeets; Giovanni Jm Tahapary; Luc Theunissen; Robert G Tieleman; Serge A Trines; Pepijn van der Voort; Geert-Jan Geersing; Frans H Rutten; Martin Ew Hemels; Menno V Huisman Journal: BMJ Open Date: 2020-08-24 Impact factor: 2.692