Warfarin underused in some patients: study

NEW YORK (Reuters Health) - Patients with atrial fibrillation — the most common type of heart arrhythmia — who suffer a stroke and are candidates for potentially life-saving anti-clotting therapy with warfarin are not prescribed the drug or are not prescribed enough of it, a study suggests.

“These findings should encourage greater efforts to prescribe and monitor appropriate antithrombotic therapy to prevent stroke in individuals with atrial fibrillation,” study chief Dr. David J. Gladstone, from Sunnybrook Health Sciences Center, Toronto, and his colleagues emphasize.

Warfarin, also known by the trade name Coumadin, can reduce the risk of stroke by preventing the formation of blood clots, which often occur in patients with atrial fibrillation. The clot may detach from the wall of the blood vessel and become lodged in the brain, blocking the flow of blood and causing a stroke.

As reported in the January issue of the journal Stroke, Gladstone’s team examined warfarin use in atrial fibrillation patients by analyzing data from the Registry of the Canadian Stroke Network, a database of consecutive stroke patients seen at 12 centers in Ontario from 2003 to 2007.

Included in the study were 597 patients with atrial fibrillation and a first stroke and 323 with a prior stroke or mini-stroke.

In the first-time stroke group, 60 percent of strokes were disabling and 20 percent were fatal. Just 10 percent of patients had optimal or “therapeutic” levels of warfarin at the time of stroke.

Twenty-nine percent of patients had warfarin at suboptimal or “subtherapeutic” levels. Single anti-clogging therapy was used in 29 percent of patients, dual anti-clotting therapy in 2 percent, and no anti-clotting drugs in 29 percent.

In the prior stroke group, only 18 percent of patients had therapeutic warfarin levels at the time of their current stroke and 39 percent had subtherapeutic warfarin. Single anti-clotting therapy was used in 25 percent of patients, dual therapy in 3 percent, and no anti-clotting drugs in 15 percent.

In a related editorial, Dr. John Worthington from Liverpool Health Service, NSW, Australia, and colleagues point out that “too often and for too long we have overstated the inconvenience of warfarin and exaggerated its risks, ignoring convincing evidence of its effectiveness in practice.”

The current study “reminds us of the perils of discounting the benefits of warfarin.”

SOURCE: Stroke, January 2009.


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