Warfarin treatment and risk of stroke among primary care patients with atrial fibrillation. (1st November 2016)

• Record Type: Journal Article
• Authors: Wändell, Per; Carlsson, Axel C.; Holzmann, Martin J; Ärnlöv, Johan; Johansson, Sven-Erik; Sundquist, Jan; Sundquist, Kristina
• Is Part Of: Scandinavian cardiovascular journal. Volume 50:Number 5/6(2016:Oct.)
• Page Start: 311
• Page End: 316
• Publication Date: 2016-11-01
• Subjects: Atrial fibrillation -- ischaemic stroke -- gender -- follow-up -- co-morbidity -- anticoagulant; Cardiovascular system -- Diseases -- Periodicals; 617.41
• DOI: 10.1080/14017431.2016.1215519
• Languages: English
• ISSNs: 1401-7431

Abstract

Abstract: Objective . Our aim was to study the risk of a first ischaemic stroke (IS) in patients with atrial fibrillation (AF) treated in primary healthcare. Design . The study population included all adults (n = 11, 517), 45 years and older diagnosed with AF, from 75 primary care centres in Sweden between 2001 and 2007. IS was defined as a hospital care event of stroke between 2001 and 2010. Association between incident stroke and warfarin treatment was explored using Cox regression analysis, with hazard ratios (HRs), and 95% confidence intervals (95%CIs). Adjustment was made for age, socioeconomic factors and co-morbidity. Results . Persistent treatment with warfarin was present among 33.7% of women and 40.0% among men. Persistent warfarin treatment, compared to no persistent treatment, was associated with a stroke preventing effect with fully adjusted HRs of 0.25 (95%CI 0.18–0.36) in women, and 0.25 (95%CI 0.19–0.32) in men. A CHA2 DS2 -VASc score of at least two among women, and three among men, was associated with a stroke risk exceeding 18% during a mean follow-up of 5.4 years. Risk of haemorrhagic stroke was not increased. Conclusions . Warfarin is effective in preventing stroke in AF patients in primary healthcare.