atrial fibrillation and stroke prevention - Continuing Medical ...
atrial fibrillation and stroke prevention - Continuing Medical ...
atrial fibrillation and stroke prevention - Continuing Medical ...
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Essentials in Primary Care Conference<br />
Wednesday, July 31, 2013<br />
Current Use of Warfarin in Preventing<br />
Stroke: A Recent Meta-Analysis<br />
• Previous Hart Meta-analysis (Ann Int Med 1999) with Warfarin<br />
revealed <strong>stroke</strong> or systemic embolism event rate at 2.09% per<br />
year with only 2 of 6 trials with time in therapeutic range (TTR)<br />
above 60%<br />
• This updated meta-analysis included 8 R<strong>and</strong>omized trials<br />
(including RE-LY, ROCKET-AF, ARISTOTLE) with 32,053 patients<br />
• Overall INR was in therapeutic range (TTR) in 7 of the 8 trials<br />
more than 60% of the time<br />
• Incidence of <strong>stroke</strong> or systemic embolism now at 1.66% per year<br />
(down from 2.09% per year) with warfarin Rx with better TTR.<br />
TAKE AWAY POINT:<br />
• There has been a significant improvement using warfarin in the<br />
proportion of time spent in therapeutic anticoagulation with a<br />
resultant decline in observed <strong>stroke</strong> rates.<br />
Agarwal S, et al. Archives Intern Med 2012;172:623-631<br />
Can We Make Warfarin Use<br />
Easier for the Patient?<br />
• Study: VKA patients on stable dose of warfarin for 6<br />
months currently on monthly f/u (n=226) with stable<br />
INR<br />
• Intervention: f/u Q4 weeks vs Q 12 weeks<br />
• Outcome :<br />
TTR (4 wk vs 12 wk): 74.1% vs 72.6% (non inferior)<br />
Major bleeding, VTE, death: No difference<br />
Intervention: f/u Q4 weeks vs Q 12 weeks<br />
• Conclusion:<br />
Q 3 months f/up of warfarin monitoring is<br />
acceptable in a patient with a stable <strong>and</strong><br />
therapeutic INR<br />
Schulman S, Ann Intern Med 2011;155:653-659<br />
Jan Basile, MD<br />
Atrial Fibrillation & Stroke Prevention