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Reduced risk of death with warfarin - results of an observational nationwide study of 20 442 patients with atrial fibrillation and ischaemic stroke

Asberg, Signild; Eriksson, Marie; Henriksson, Karin LU and Terent, Andreas (2013) In International Journal of Stroke 8(8). p.689-695
Abstract
BackgroundWarfarin is demonstrated to be superior in efficacy over antiplatelet agents for the prevention of stroke, but the relationship between warfarin and mortality is less clear. Our aim was to investigate this relationship in a large cohort of unselected patients with atrial fibrillation and ischaemic stroke. MethodsThis observational study was based on patients who were discharged alive and registered in the Swedish Stroke Register in 2001 through 2005. Vital status was retrieved by linkage to the Swedish Cause of Death Register. We calculated a propensity score for the likelihood of warfarin prescription at discharge from hospital. The risk of death and 95% confidence intervals were estimated in Cox regression models. ResultsOut of... (More)
BackgroundWarfarin is demonstrated to be superior in efficacy over antiplatelet agents for the prevention of stroke, but the relationship between warfarin and mortality is less clear. Our aim was to investigate this relationship in a large cohort of unselected patients with atrial fibrillation and ischaemic stroke. MethodsThis observational study was based on patients who were discharged alive and registered in the Swedish Stroke Register in 2001 through 2005. Vital status was retrieved by linkage to the Swedish Cause of Death Register. We calculated a propensity score for the likelihood of warfarin prescription at discharge from hospital. The risk of death and 95% confidence intervals were estimated in Cox regression models. ResultsOut of the 20442 patients with atrial fibrillation and ischaemic stroke (mean age=79<bold>5</bold> years), 31% (n=6399) were prescribed warfarin. After adjustment for the propensity score, warfarin was associated with a reduced risk of death (0<bold>67</bold>; 95% confidence interval, 0<bold>63</bold>-0<bold>71</bold>). The crude rate (per 100 person-years) of fatal non-haemorrhagic stroke was lower in patients who received warfarin (1<bold>60</bold>; 95% confidence interval, 1<bold>34</bold>-1<bold>89</bold>) compared to those who received antiplatelet (6<bold>83</bold>; 95% confidence interval, 6<bold>42</bold>-7<bold>25</bold>). The rates (per 100 person-years) of fatal haemorrhagic stroke were 0<bold>21</bold> (95% confidence interval, 0<bold>12</bold>-0<bold>32</bold>) and 0<bold>43</bold> (95% confidence interval, 0<bold>34</bold>-0<bold>55</bold>) in patients prescribed warfarin and antiplatelet therapy, respectively. ConclusionsIn addition to its established benefit for stroke prevention, warfarin therapy in patients with atrial fibrillation and ischaemic stroke was associated with a reduced risk of death, without an increased risk of fatal haemorrhagic stroke. (Less)
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author
organization
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type
Contribution to journal
publication status
published
subject
keywords
anticoagulants, antiplatelets, atrial fibrillation, epidemiology, ischaemic stroke, mortality
in
International Journal of Stroke
volume
8
issue
8
pages
689 - 695
publisher
Wiley-Blackwell
external identifiers
  • wos:000327257600020
  • scopus:84888103002
ISSN
1747-4949
DOI
10.1111/j.1747-4949.2012.00855.x
language
English
LU publication?
yes
id
96df8c79-8e8c-4c0f-a847-81df23121049 (old id 4196592)
date added to LUP
2014-01-02 12:33:19
date last changed
2019-07-30 01:09:56
@article{96df8c79-8e8c-4c0f-a847-81df23121049,
  abstract     = {BackgroundWarfarin is demonstrated to be superior in efficacy over antiplatelet agents for the prevention of stroke, but the relationship between warfarin and mortality is less clear. Our aim was to investigate this relationship in a large cohort of unselected patients with atrial fibrillation and ischaemic stroke. MethodsThis observational study was based on patients who were discharged alive and registered in the Swedish Stroke Register in 2001 through 2005. Vital status was retrieved by linkage to the Swedish Cause of Death Register. We calculated a propensity score for the likelihood of warfarin prescription at discharge from hospital. The risk of death and 95% confidence intervals were estimated in Cox regression models. ResultsOut of the 20442 patients with atrial fibrillation and ischaemic stroke (mean age=79&lt;bold&gt;5&lt;/bold&gt; years), 31% (n=6399) were prescribed warfarin. After adjustment for the propensity score, warfarin was associated with a reduced risk of death (0&lt;bold&gt;67&lt;/bold&gt;; 95% confidence interval, 0&lt;bold&gt;63&lt;/bold&gt;-0&lt;bold&gt;71&lt;/bold&gt;). The crude rate (per 100 person-years) of fatal non-haemorrhagic stroke was lower in patients who received warfarin (1&lt;bold&gt;60&lt;/bold&gt;; 95% confidence interval, 1&lt;bold&gt;34&lt;/bold&gt;-1&lt;bold&gt;89&lt;/bold&gt;) compared to those who received antiplatelet (6&lt;bold&gt;83&lt;/bold&gt;; 95% confidence interval, 6&lt;bold&gt;42&lt;/bold&gt;-7&lt;bold&gt;25&lt;/bold&gt;). The rates (per 100 person-years) of fatal haemorrhagic stroke were 0&lt;bold&gt;21&lt;/bold&gt; (95% confidence interval, 0&lt;bold&gt;12&lt;/bold&gt;-0&lt;bold&gt;32&lt;/bold&gt;) and 0&lt;bold&gt;43&lt;/bold&gt; (95% confidence interval, 0&lt;bold&gt;34&lt;/bold&gt;-0&lt;bold&gt;55&lt;/bold&gt;) in patients prescribed warfarin and antiplatelet therapy, respectively. ConclusionsIn addition to its established benefit for stroke prevention, warfarin therapy in patients with atrial fibrillation and ischaemic stroke was associated with a reduced risk of death, without an increased risk of fatal haemorrhagic stroke.},
  author       = {Asberg, Signild and Eriksson, Marie and Henriksson, Karin and Terent, Andreas},
  issn         = {1747-4949},
  keyword      = {anticoagulants,antiplatelets,atrial fibrillation,epidemiology,ischaemic stroke,mortality},
  language     = {eng},
  number       = {8},
  pages        = {689--695},
  publisher    = {Wiley-Blackwell},
  series       = {International Journal of Stroke},
  title        = {Reduced risk of death with warfarin - results of an observational nationwide study of 20 442 patients with atrial fibrillation and ischaemic stroke},
  url          = {http://dx.doi.org/10.1111/j.1747-4949.2012.00855.x},
  volume       = {8},
  year         = {2013},
}