Warfarin after ischemic stroke improves outcomes, increases time at home for patients with AF

Administering warfarin in patients with atrial fibrillation after an ischemic stroke improves long-term clinical outcomes and reduces time spent in a medical facility, according to study results published in the BMJ.

“We found that new prescription of warfarin treatment in patients with atrial fibrillation was associated with a lower risk of [major adverse cardiac events], all-cause mortality and readmission for ischemic stroke, as well as more institution-free home time,” the researchers wrote.

Ying Xian, MD, PhD, assistant professor of medicine, Duke Clinical Research Institute, Durham, NC, and a team of researchers examined data from a stroke guidelines program associated with the CMS. The study enrolled 12,552 patients with atrial fibrillation (AF) admitted to 1,487 hospitals following a stroke who had not been treated previously with warfarin.

Ying Xian

At discharge, 11,039 patients (88%) were prescribed warfarin. These patients were slightly younger and less commonly had a history of stroke or CAD; however, they had similar stroke severity compared with patients not prescribed oral anticoagulation therapy, as determined by a stroke scale from the NIH.

The investigators longitudinally assessed MACE and home time, defined as the number of days not in institutional care after discharge. The team accounted for between-group differences in observed characteristics using a propensity score inverse probability weighting method.

Patients treated with warfarin experienced more days at home in 2 years following discharge (adjusted home time difference, 47.6 days; 99% CI, 26.9-68.2). This group also demonstrated a lower risk for MACE (adjusted HR = 0.87; 99% CI, 0.78-0.98), recurrent ischemic stroke (adjusted HR = 0.63; 99% CI, 0.48-0.83) and all-cause mortality (adjusted HR = 0.72; 99% CI, 0.63-0.84). The differences were seen across clinically relevant subgroups based on age, sex and stroke severity, as well as history of CAD and stroke.

“These findings support the routine use of warfarin treatment for eligible ischemic stroke patients with atrial fibrillation, including those over 80 years of age, women, those with more severe strokes and those with comorbid conditions,” the researchers wrote. – by Julia Ernst, MS 

Source: www.healio.com