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Showing content from http://www.ncbi.nlm.nih.gov/pubmed/23184840 below:

Rates of hemorrhage during warfarin therapy for atrial fibrillation

Affiliations

• ¹ The Leslie Dan Faculty of Pharmacy, Universityof Toronto, Canada. tara.gomes@ices.on.ca

• PMID: 23184840
• PMCID: PMC3563912
• DOI: 10.1503/cmaj.121218

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Tara Gomes et al. CMAJ. 2013.

• ¹ The Leslie Dan Faculty of Pharmacy, Universityof Toronto, Canada. tara.gomes@ices.on.ca

• PMID: 23184840
• PMCID: PMC3563912
• DOI: 10.1503/cmaj.121218

Item in Clipboard

Background: Although warfarin has been extensively studied in clinical trials, little is known about rates of hemorrhage attributable to its use in routine clinical practice. Our objective was to examine incident hemorrhagic events in a large population-based cohort of patients with atrial fibrillation who were starting treatment with warfarin.

Methods: We conducted a population-based cohort study involving residents of Ontario (age ≥ 66 yr) with atrial fibrillation who started taking warfarin between Apr. 1, 1997, and Mar. 31, 2008. We defined a major hemorrhage as any visit to hospital for hemorrage. We determined crude rates of hemorrhage during warfarin treatment, overall and stratified by CHADS(2) score (congestive heart failure, hypertension, age ≥ 75 yr, diabetes mellitus and prior stroke, transient ischemic attack or thromboembolism).

Results: We included 125 195 patients with atrial fibrillation who started treatment with warfarin during the study period. Overall, the rate of hemorrhage was 3.8% (95% confidence interval [CI] 3.8%-3.9%) per person-year. The risk of major hemorrhage was highest during the first 30 days of treatment. During this period, rates of hemorrhage were 11.8% (95% CI 11.1%-12.5%) per person-year in all patients and 16.7% (95% CI 14.3%-19.4%) per person-year among patients with a CHADS(2) scores of 4 or greater. Over the 5-year follow-up, 10 840 patients (8.7%) visited the hospital for hemorrhage; of these patients, 1963 (18.1%) died in hospital or within 7 days of being discharged.

Interpretation: In this large cohort of older patients with atrial fibrillation, we found that rates of hemorrhage are highest within the first 30 days of warfarin therapy. These rates are considerably higher than the rates of 1%-3% reported in randomized controlled trials of warfarin therapy. Our study provides timely estimates of warfarin-related adverse events that may be useful to clinicians, patients and policy-makers as new options for treatment become available.

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Incident rate of visits to…

Incident rate of visits to hospital with hemorrhages in 30-day increments after the…

Incident rate of visits to hospital with hemorrhages in 30-day increments after the start of warfarin therapy among older patients (≥ 66 yr) with atrial fibrillation. Rates are stratified by CHADS₂ score at the start of treatment.

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