title: Warfarin usage among elderly atrial fibrillation patients with traumatic injury, an analysis of United States Medicare fee-for-service enrollees.
abstract: This study examined warfarin usage for elderly Medicare beneficiaries with atrial fibrillation (AF) who suffered traumatic brain injury (TBI), hip fracture, or torso injuries. Using the 5% Chronic Condition Data Warehouse administrative claims data, this study included fee-for-service Medicare beneficiaries who had a single injury hospitalization (TBI, hip fracture, or major torso injury) between 1/1/2007 and 12/31/2009, with complete Medicare Parts A, B (no Medicare Advantage), and D coverage 6 months before injury, and who were aged 66 years or older and diagnosed with AF at least 1 year before injury. About 45% of the AF patients were using warfarin before TBI or torso injury, and 35% before hip fracture. After injury, there was a dramatic and persistent decrease in warfarin use in TBI and torso injury groups (30% for TBI and 37% for torso injury at 12 months after injury). Warfarin usage in hip fracture patients also dropped after injury but returned to pre-injury level within 4 months. TBI and torso injury lead to significant decreases in warfarin usage in elderly AF patients. Further research is needed to understand reasons for the pattern and to develop evidence-based management strategies in the post-acute setting.
authors.affiliation: University of Maryland, School of Pharmacy, Baltimore, Maryland, USA.
authors.forename: Xinggang
authors.initials: X
authors.lastname: Liu
authors.forename: Mona
authors.initials: M
authors.lastname: Baumgarten
authors.forename: Gordon
authors.initials: G
authors.lastname: Smith
authors.forename: Steven
authors.initials: S
authors.lastname: Gambert
authors.forename: Stephen
authors.initials: S
authors.lastname: Gottlieb
authors.forename: Gail
authors.initials: G
authors.lastname: Rattinger
authors.forename: Jennifer
authors.initials: J
authors.lastname: Albrecht
authors.forename: Patricia
authors.initials: P
authors.lastname: Langenberg
authors.forename: Ilene
authors.initials: I
authors.lastname: Zuckerman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001930:Brain Injuries / Q000188:drug therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans; D005260:Female; D006620:Hip Fractures / Q000188:drug therapy*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D060726:Torso / Q000293:injuries; D014481:United States; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: stroke; traumatic injury; warfarin
references.citation: J Trauma. 2010 Apr;68(4):916-23
references.pmid: 19996796
references.citation: Ann Pharmacother. 2008 Apr;42(4):523-32
references.pmid: 18334606
references.citation: Thromb Haemost. 2009 Feb;101(2):290-7
references.pmid: 19190812
references.citation: Stroke. 2010 Sep;41(9):2108-29
references.pmid: 20651276
references.citation: Transfusion. 2013 Jan;53 Suppl 1:59S-64S
references.pmid: 23301974
references.citation: Ann Pharmacother. 2013 Jan;47(1):35-42
references.pmid: 23324508
references.citation: Stroke. 2006 Apr;37(4):1075-80
references.pmid: 16527999
references.citation: J Trauma. 2010 Apr;68(4):886-94
references.pmid: 20386284
references.citation: BMJ. 2006 Jan 21;332(7534):141-5
references.pmid: 16403771
references.citation: Am J Geriatr Cardiol. 2005 Mar-Apr;14(2):56-61
references.pmid: 15785146
references.citation: Am J Emerg Med. 2000 Sep;18(5):575-80
references.pmid: 10999573
references.citation: Arch Intern Med. 1999 Apr 12;159(7):677-85
references.pmid: 10218746
references.citation: J Trauma. 2002 Jan;52(1):79-84
references.pmid: 11791055
references.citation: Chest. 2012 Feb;141(2 Suppl):e531S-e575S
references.pmid: 22315271
references.citation: Ann Intern Med. 1999 Oct 5;131(7):492-501
references.pmid: 10507957
references.citation: Stroke. 2010 Dec;41(12):2860-6
references.pmid: 21030703
references.citation: Am Surg. 2001 Nov;67(11):1098-100
references.pmid: 11730229
references.citation: Stroke. 1991 Aug;22(8):983-8
references.pmid: 1866765
references.citation: Stroke. 2006 Apr;37(4):1070-4
references.pmid: 16528001
references.citation: Arch Intern Med. 2000 Jan 10;160(1):41-6
references.pmid: 10632303
references.citation: J Trauma Acute Care Surg. 2012 Dec;73(6):1434-41
references.pmid: 22914079
references.citation: Arch Intern Med. 2004 Jan 12;164(1):55-60
references.pmid: 14718322
references.citation: J Am Coll Cardiol. 2005 Nov 1;46(9):1729-36
references.pmid: 16256877
references.citation: Neurology. 2013 May 28;80(22):2065-9
references.pmid: 23713086