title: Effect of warfarin on outcomes in septuagenarian patients with atrial fibrillation.
abstract: Anticoagulation has been shown to decrease ischemic stroke in atrial fibrillation (AF). However, concerns remain regarding their safety and efficacy in those ≥70 years of age who constitute most patients with AF. Of the 4,060 patients (mean age 65 years, range 49 to 80) in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, 2,248 (55% of 4,060) were 70 to 80 years of age, 1,901 of whom were receiving warfarin. Propensity score for warfarin use, estimated for each of the 2,248 patients, was used to match 227 of the 347 patients not on warfarin (in 1:1, 1:2, or 1:3 sets) to 616 patients on warfarin who were balanced in 45 baseline characteristics. All-cause mortality occurred in 18% and 33% of matched patients receiving and not receiving warfarin, respectively, during up to 6 years (mean 3.4) of follow-up (hazard ratio [HR] when warfarin use was compared to its nonuse 0.58, 95% confidence interval [CI] 0.43 to 0.77, p <0.001). All-cause hospitalization occurred in 64% and 67% of matched patients receiving and not receiving warfarin, respectively (HR associated with warfarin use 0.93, 95% CI 0.77 to 1.12, p = 0.423). Ischemic stroke occurred in 4% and 8% of matched patients receiving and not receiving warfarin, respectively (HR associated with warfarin use 0.57, 95% CI 0.31 to 1.04, p = 0.068). Major bleeding occurred in 7% and 10% of matched patients receiving and not receiving warfarin, respectively (HR associated with warfarin use 0.73, 95% CI 0.44 to 1.22, p = 0.229). In conclusion, warfarin use was associated with decreased mortality in septuagenarian patients with AF but had no association with hospitalization or major bleeding.
authors: University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors: Brita
authors: B
authors: Roy
authors: Ravi V
authors: RV
authors: Desai
authors: Marjan
authors: M
authors: Mujib
authors: Andrew E
authors: AE
authors: Epstein
authors: Yan
authors: Y
authors: Zhang
authors: Jason
authors: J
authors: Guichard
authors: Linda G
authors: LG
authors: Jones
authors: Margaret A
authors: MA
authors: Feller
authors: Mustafa I
authors: MI
authors: Ahmed
authors: Inmaculada B
authors: IB
authors: Aban
authors: Thomas E
authors: TE
authors: Love
authors: Raynald
authors: R
authors: Levesque
authors: Michel
authors: M
authors: White
authors: Wilbert S
authors: WS
authors: Aronow
authors: Gregg C
authors: GC
authors: Fonarow
authors: Ali
authors: A
authors: Ahmed
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin