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Warfarin treatment and risk of myocardial infarction — A cohort study of patients with atrial fibrillation treated in primary health care

Wändell, Per LU ; Carlsson, Axel C. ; Holzmann, Martin J. ; Ärnlöv, Johan ; Johansson, Sven Erik LU ; Sundquist, Jan LU and Sundquist, Kristina LU (2016) In International Journal of Cardiology 221. p.789-793
Abstract

Objective To study the risk of myocardial infarction (MI) in patients with atrial fibrillation (AF) treated in primary health care with warfarin or acetylsalicylic acid (ASA, aspirin). Methods The study population included subjects (n = 12,283) 45 years or older diagnosed with AF who were treated in 75 primary care centres in Sweden between 2001 and 2007. MI was defined as a hospital stay for MI during 2001 through 2010 registered in the Swedish Patient Register. Associations between warfarin or ASA treatment and incident MI were explored using Cox regression analysis, by estimating hazard ratios (HRs) and 95% confidence intervals (95% CIs). Adjustment was made for age, socio-economic factors and cardio-vascular co-morbidity. Results... (More)

Objective To study the risk of myocardial infarction (MI) in patients with atrial fibrillation (AF) treated in primary health care with warfarin or acetylsalicylic acid (ASA, aspirin). Methods The study population included subjects (n = 12,283) 45 years or older diagnosed with AF who were treated in 75 primary care centres in Sweden between 2001 and 2007. MI was defined as a hospital stay for MI during 2001 through 2010 registered in the Swedish Patient Register. Associations between warfarin or ASA treatment and incident MI were explored using Cox regression analysis, by estimating hazard ratios (HRs) and 95% confidence intervals (95% CIs). Adjustment was made for age, socio-economic factors and cardio-vascular co-morbidity. Results Persistent treatment (“per protocol” treatment) with warfarin alone was present among 32.4% of women and 37.4% of men, and with ASA alone among 30.0% of women and 28.1% of men. The fully adjusted HRs for MI, compared to those with no antithrombotic treatment, with warfarin treatment for women were 0.26 (95% CI 0.16–0.41) and for men 0.28 (95% CI 0.20–0.39); and the corresponding HRs for those treated with ASA were for women 0.57 (95% CI 0.37–0.87), and for men 0.44 95% CI (0.31–0.63). The fully adjusted HR for MI when comparing patients with warfarin treatment to those with ASA treatment was for women 0.46 (95% CI 0.27–0.80), and for men 0.58 (95% CI 0.38–0.89). Conclusions Warfarin seems to prevent MI among AF patients in a primary healthcare setting, which emphasizes the importance of persistent anticoagulant treatment in those patients.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Anticoagulants, Antiplatelets, Atrial fibrillation, Co-morbidity, Follow-up, Gender, Myocardial infarction
in
International Journal of Cardiology
volume
221
pages
5 pages
publisher
Elsevier
external identifiers
  • wos:000384692600149
  • pmid:27428322
  • scopus:84978924486
ISSN
0167-5273
DOI
10.1016/j.ijcard.2016.07.119
language
English
LU publication?
yes
id
9c1e1e5d-8325-4b33-9bad-6999327ba8d6
date added to LUP
2016-08-18 16:26:20
date last changed
2025-01-12 09:57:44
@article{9c1e1e5d-8325-4b33-9bad-6999327ba8d6,
  abstract     = {{<p>Objective To study the risk of myocardial infarction (MI) in patients with atrial fibrillation (AF) treated in primary health care with warfarin or acetylsalicylic acid (ASA, aspirin). Methods The study population included subjects (n = 12,283) 45 years or older diagnosed with AF who were treated in 75 primary care centres in Sweden between 2001 and 2007. MI was defined as a hospital stay for MI during 2001 through 2010 registered in the Swedish Patient Register. Associations between warfarin or ASA treatment and incident MI were explored using Cox regression analysis, by estimating hazard ratios (HRs) and 95% confidence intervals (95% CIs). Adjustment was made for age, socio-economic factors and cardio-vascular co-morbidity. Results Persistent treatment (“per protocol” treatment) with warfarin alone was present among 32.4% of women and 37.4% of men, and with ASA alone among 30.0% of women and 28.1% of men. The fully adjusted HRs for MI, compared to those with no antithrombotic treatment, with warfarin treatment for women were 0.26 (95% CI 0.16–0.41) and for men 0.28 (95% CI 0.20–0.39); and the corresponding HRs for those treated with ASA were for women 0.57 (95% CI 0.37–0.87), and for men 0.44 95% CI (0.31–0.63). The fully adjusted HR for MI when comparing patients with warfarin treatment to those with ASA treatment was for women 0.46 (95% CI 0.27–0.80), and for men 0.58 (95% CI 0.38–0.89). Conclusions Warfarin seems to prevent MI among AF patients in a primary healthcare setting, which emphasizes the importance of persistent anticoagulant treatment in those patients.</p>}},
  author       = {{Wändell, Per and Carlsson, Axel C. and Holzmann, Martin J. and Ärnlöv, Johan and Johansson, Sven Erik and Sundquist, Jan and Sundquist, Kristina}},
  issn         = {{0167-5273}},
  keywords     = {{Anticoagulants; Antiplatelets; Atrial fibrillation; Co-morbidity; Follow-up; Gender; Myocardial infarction}},
  language     = {{eng}},
  month        = {{10}},
  pages        = {{789--793}},
  publisher    = {{Elsevier}},
  series       = {{International Journal of Cardiology}},
  title        = {{Warfarin treatment and risk of myocardial infarction — A cohort study of patients with atrial fibrillation treated in primary health care}},
  url          = {{http://dx.doi.org/10.1016/j.ijcard.2016.07.119}},
  doi          = {{10.1016/j.ijcard.2016.07.119}},
  volume       = {{221}},
  year         = {{2016}},
}