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Warfarin helpful in the elderly with atrial fibrillation

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – In general, warfarin anticoagulation is beneficial in septuagenarians with atrial fibrillation, researchers report in a November 28th on-line paper in the American Journal of Cardiology.

Co-senior author Dr. Gregg C. Fonarow, told Reuters Health by email, “Anticoagulation has been demonstrated to be very efficacious in decreasing the risk of stroke in patients with atrial fibrillation, however there remain concerns regarding the safety and net clinical benefit in adults older than 70 years of age.”

This analysis, he added, “has shown that anticoagulation was associated with decreased mortality in atrial fibrillation patients age 70 and above without a significant increase risk of major bleeding.”

Dr. Fonarow of the University of California, Los Angeles, and colleagues came to this conclusion after studying data on patients aged 70 to 80 years taking part in an atrial fibrillation study. All were without contraindication to anticoagulant therapy and were considered at high risk of stroke.

The team compared 616 patients receiving warfarin with 227 well-matched controls who did not get the drug.

After up to 6 years of follow-up, 18% of the warfarin group and 33% of controls had died (hazard ratio, 0.58). There was no difference in all-cause hospitalization (64% versus 67%) or in major bleeding (7% versus 10%). The difference in ischemic stroke, however, was considerable and almost reached significance (4% versus 8%).

“These findings,” concluded Dr. Fonarow, “suggest that in appropriately monitored older adults with atrial fibrillation, the benefits of anticoagulation greatly outweigh the risks in the absence of contraindications to anticoagulation.”

Reference:

Effect of Warfarin on Outcomes in Septuagenarian Patients With Atrial Fibrillation

Am J Cardiol 2011.