http://www.theheart.org/article/1479805.do?utm_medium=email&utm_source=20121128_EN_Heartwire&utm_campaign=newsletter
Results of a large observational study of warfarin use in AF patients suggest that major bleeding rates are higher than in clinical trials and are often fatal [1].
The authors, led by Tara Gomes
(University of Toronto, ON), conclude that the 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."
For the study, published online in CMAJ
on November 26, 2012, Gomes and colleagues linked health administrative
databases on prescription drugs and hospitalizations in Ontario. They
identified 125 195 patients aged 66 years or over with AF who started
warfarin between April 1997 and March 2008. Over the 13-year study
period, the rate of major bleeding (defined as any visit to hospital for
hemorrhage) was 3.8% per person-year.
Gomes told heartwire
that these results were important, as "they reflect the bleeding rates
with warfarin in the real world." She said the bleeding rate was
"slightly higher than we expected, given that clinical trials have shown
rates of major bleeding with warfarin between 1% and 3%."
Noting that some other observational studies
have suggested higher bleeding rates than this, she pointed out that
many of these studies had much shorter follow-up, and bleeding rates
tend to be higher in the early treatment period. "We had a long
follow-up period, and as time elapses patients tend to stabilize, so
bleeding rates come down."
Tables at the link.
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