Effect of warfarin on outcomes in septuagenarian patients with atrial fibrillation.

Pubmed ID: 22118824

Pubmed Central ID: PMC3390022

Journal: The American journal of cardiology

Publication Date: Feb. 1, 2012

Affiliation: University of Alabama at Birmingham, Birmingham, Alabama, USA.

MeSH Terms: Humans, Male, Female, Aged, Aged, 80 and over, Risk Factors, United States, Age Factors, Middle Aged, Atrial Fibrillation, Treatment Outcome, Prospective Studies, Follow-Up Studies, Incidence, Stroke, Survival Rate, Time Factors, Anticoagulants, Warfarin, Age Distribution, Dose-Response Relationship, Drug, Quebec

Grants: R01 HL085561, R01-HL085561, R01 HL085561-03, R01 HL085561-03S1, R01 HL097047, R01 HL097047-02, R01-HL097047, R01-HL085561-S

Authors: Ahmed MI, White M, Love TE, Aronow WS, Ahmed A, Mujib M, Roy B, Desai RV, Fonarow GC, Zhang Y, Feller MA, Aban IB, Levesque R, Jones LG, Epstein AE, Guichard J

Cite As: Roy B, Desai RV, Mujib M, Epstein AE, Zhang Y, Guichard J, Jones LG, Feller MA, Ahmed MI, Aban IB, Love TE, Levesque R, White M, Aronow WS, Fonarow GC, Ahmed A. Effect of warfarin on outcomes in septuagenarian patients with atrial fibrillation. Am J Cardiol 2012 Feb 1;109(3):370-7. Epub 2011 Nov 24.

Studies:

Abstract

Anticoagulation has been shown to decrease ischemic stroke in atrial fibrillation (AF). However, concerns remain regarding their safety and efficacy in those ≥70 years of age who constitute most patients with AF. Of the 4,060 patients (mean age 65 years, range 49 to 80) in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, 2,248 (55% of 4,060) were 70 to 80 years of age, 1,901 of whom were receiving warfarin. Propensity score for warfarin use, estimated for each of the 2,248 patients, was used to match 227 of the 347 patients not on warfarin (in 1:1, 1:2, or 1:3 sets) to 616 patients on warfarin who were balanced in 45 baseline characteristics. All-cause mortality occurred in 18% and 33% of matched patients receiving and not receiving warfarin, respectively, during up to 6 years (mean 3.4) of follow-up (hazard ratio [HR] when warfarin use was compared to its nonuse 0.58, 95% confidence interval [CI] 0.43 to 0.77, p <0.001). All-cause hospitalization occurred in 64% and 67% of matched patients receiving and not receiving warfarin, respectively (HR associated with warfarin use 0.93, 95% CI 0.77 to 1.12, p = 0.423). Ischemic stroke occurred in 4% and 8% of matched patients receiving and not receiving warfarin, respectively (HR associated with warfarin use 0.57, 95% CI 0.31 to 1.04, p = 0.068). Major bleeding occurred in 7% and 10% of matched patients receiving and not receiving warfarin, respectively (HR associated with warfarin use 0.73, 95% CI 0.44 to 1.22, p = 0.229). In conclusion, warfarin use was associated with decreased mortality in septuagenarian patients with AF but had no association with hospitalization or major bleeding.