Sl. Jackson et al., Outcomes in the management of atrial fibrillation: clinical trial results can apply in practice, INTERN M J, 31(6), 2001, pp. 329-336
Citations number
28
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Background: The benefits of antithrombotic therapy in chronic atrial fibril
lation (AF) have been established in clinical trials, but there is a paucit
y of data on outcomes in practice.
Aims: The objective was to establish a large ongoing database of patients w
ith non-valvular AF, to enable the accurate determination of clinical outco
mes.
Methods: A retrospective review of the medical records for consecutive pati
ents who had AF documented on electrocardiogram at the major teaching hospi
tal in Tasmania between 1 January 1997 and 30 June 1999 was performed. An e
xtensive range of demographic and clinical variables was recorded for all p
atients with chronic or paroxysmal non-valvular AF.
Results: The 505 patients (60% males) included in the database had a median
age of 76 years. According to risk stratification criteria, 79% of the pat
ients with previously diagnosed chronic or paroxysmal AF had a high risk of
developing stroke at the time of admission to hospital care. However, only
one-third (34%) of these patients were receiving warfarin (or warfarin plu
s aspirin), with almost one-quarter (24%) receiving no antithrombotic agent
. The annual incidence of ischaemic strokes was 3.4% (1.5-6.4%; 95% CI) whe
n taking warfarin, compared to 7.0% (5.2-9.4%) for patients not taking warf
arin and 7.8% (5.4-11.1%) for patients taking aspirin. The annual incidence
of bleeding complications in patients taking warfarin was 14.2% (10.0-19.5
%) overall and 3.4% (1.5-6.4%) for major bleeds. In patients not taking war
farin, the overall annual incidence of bleeds was 8.4% (6.3-10.9%) and 3.9%
(2.5-5.7%) for major bleeds.
Conclusions: Warfarin is underused in patients with AF. In clinical practic
e, warfarin confers a similar stroke risk reduction to that observed in tri
als, with an increase in incidence of only minor bleeding complications. As
pirin did not appear to reduce the risk of stroke.