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Warfarin persistence among stroke patients with atrial fibrillation

Fredrik Björck1, Henrik Renlund2, Peter J Svensson3

  • 1Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

Thrombosis Research
|August 9, 2015
PubMed

Insights

Warfarin persistence is higher in Swedish atrial fibrillation (AF) patients with stroke than previously reported. However, factors like dementia, alcohol abuse, and higher CHA2DS2VASc scores are linked to lower warfarin persistence.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Warfarin discontinuation is a significant issue for patients with atrial fibrillation (AF).
  • Previous studies reported low warfarin persistence rates (0.45 after 2 years) in AF patients post-stroke.
  • Consistent predictors for warfarin discontinuation remain unestablished.

Purpose of the Study:

  • To evaluate warfarin persistence and identify variables associated with discontinuation.
  • Focus on a large Swedish cohort of unselected stroke/transient ischemic attack (TIA) patients with AF treated with warfarin.

Main Methods:

  • Utilized the Swedish National Patient Register (NPR) and the AuriculA quality register.
  • Included 4,583 patients with stroke/TIA and AF from January 2006 to December 2011.
  • Followed patients for treatment cessation, death, or end of study, retrieving baseline characteristics and CHA2DS2VASc scores.

Main Results:

  • Warfarin persistence rates were 0.78 (1 year), 0.69 (2 years), and 0.47 (5 years).
  • Dementia (HR 2.22) and alcohol abuse (HR 1.66) were strongly associated with higher discontinuation.
  • COPD, cancer, CHF, higher CHA2DS2VASc score, and older start-age were linked to increased discontinuation risk.

Conclusions:

  • Warfarin persistence in Swedish stroke/TIA patients with AF is higher than previously reported.
  • Factors such as dementia, alcohol abuse, cancer, CHF, COPD, older age, and high CHA2DS2VASc scores are associated with lower persistence.
Abstract

Keywords:
Atrial fibrillationDiscontinuationPersistenceStrokeTreatmentWarfarin

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