Contra: 'Warfarin should be the drug of choice for thromboprophylaxis in elderly patients with atrial fibrillation'

Elaine M. Hylek

doi:10.1160/TH08-06-0343

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2008; 100(01): 16-17
DOI: 10.1160/TH08-06-0343

Pro / Contra Articles

Schattauer GmbH

Contra: 'Warfarin should be the drug of choice for thromboprophylaxis in elderly patients with atrial fibrillation'

Caveats regarding use of oral anticoagulant therapy among elderly patients with atrial fibrillation

Elaine M. Hylek

¹Research Unit-Section of General Internal Medicine and Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachussetts, USA

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Abstract

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References
1 van der Meer FJ, Rosendaal FR, Vandenbroucke JP. et al. Bleeding complications in oral anticoagulant therapy. An analysis of risk factors. Arch Intern Med 1993; 153: 1557-1562.
2 The Stroke Prevention in Atrial Fibrillation Investigators. Bleeding during antithrombotic therapy in patients with atrial fibrillation. Arch Intern Med 1996; 156: 409-416.
3 DiMarco JP, Flaker G, Waldo AL. et al. and the AF-FIRM Investigators. Factors affecting bleeding risk during anticoagulant therapy in patients with atrial fibrillation. Am Heart J 2005; 149: 650-656.
4 Hylek EM, Evans-Molina C, Shea C. et al. Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation 2007; 115: 268-2696.
5 The Amadeus Investigators. Comparison of idraparinux with vitamin K antagonists for prevention of thromboembolism in patients with atrial fibrillation: a randomized, open-label, noninferiority trial. Lancet 2008; 371: 315-321.
6 Hughes M, Lip GY. Guideline Development Group. National Clinical Guideline for Management of Atrial Fibrillation in Primary and Secondary Care, National Institute for Health and Clinical Excellence. Stroke and thromboembolism in atrial fibrillation: a systematic review of stroke risk factors, risk stratification schema and cost effectiveness data. Thromb Haemost 2008; 99: 295-304.
7 Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: A population-based study. Am J Gastroenterol 1997; 92: 419-424.
8 Hernandez-Diaz S, Garcia Rodriguez LA. Cardioprotective aspirin users and their excess risk of upper gastrointestinal complications. BMC Med 2006; 04: 22-28.
9 Bolla M, Momi S, Gresele P. et al. Nitric oxide-donating aspirin (NCX 4016): an overview of its pharmacological properties and clinical perspectives. Eur J Clin Pharmacol 2005; 26: 1-10.
10 Rosand J, Hylek EM, O'Donnell HC. et al. Warfarin-associated hemorrhage and cerebral amyloid angiopathy: a genetic and pathologic study. Neurology 2000; 55: 947-951.
11 Smith EE, Rosand J, Knudsen KA. et al. Leukoaraiosis is associated with warfarin-related hemorrhage following ischemic stroke. Neurology 2002; 59: 193-197.
12 Gage BF, Birman-Deych E, Kerzner R. et al. Incidence of intracranial hemorrhage in patients with atrial fibrillation who are prone to fall. Am J Med 2005; 118: 612-617.
13 Poli D, Antonucci E, Marcucci R. et al. Risk of bleeding in very old atrial fibrillation patients on warfarin: Relationship with ageing and CHADS₂ score. Thromb Res 2007; 121: 347-352.
14 Healey JS, Hart RG, Pogue J. et al. Risks and benefits of oral anticoagulation compared with clopidogrel plus aspirin in patients with atrial fibrillation according to stroke risk. Stroke 2008; 39: 1-5.
15 Fang MC, Go AS, Chang Y. et al. Death and disability from warfarin-associated intracranial and extracranial hemorrhages. Am J Med 2007; 120: 700-705.
16 Lin H, Wolf PA, Kelly-Hayes M. et al. Stroke Severity in Atrial Fibrillation: The Framingham Study. Stroke 1996; 27: 1760-1764.
17 Hylek EM, Go AS, Chang Y. et al. Effect of Intensity of Oral Anticoagulation on Stroke Severity and Mortality in Atrial Fibrillation. N Engl J Med 2003; 349: 1019-1026.
18 Dentali F, Douketis JD, Lim W. et al. Combined aspirin-oral anticoagulant therapy compared with oral anticoagulant therapy alone among patients at risk for cardiovascular disease: a meta-analysis of randomized trials. Arch Intern Med 2007; 167: 117-124.
19 Hart RG, Tonarelli SB, Pearce LA. Avoiding central nervous system bleeding during antithrombotic therapy: recent data and ideas. Stroke 2005; 36: 1588-1593.
20 Lip GY, Frison L, Grind M. Effect of hypertension on anticoagulated patients with atrial fibrillation. Eur Heart J 2007; 28: 752-759.
21 Garcia D, Regan S, Crowther M. et al. Warfarin maintenance dosing patterns in clinical practice: Implications for safer anticoagulation in the elderly population. Chest 2005; 127: 2049-2056.