title: Real world effectiveness of warfarin among ischemic stroke patients with atrial fibrillation: observational analysis from Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) study.
abstract: OBJECTIVE
  To examine the association between warfarin treatment and longitudinal outcomes after ischemic stroke in patients with atrial fibrillation in community practice.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Hospitals (n = 1487) participating in the Get With The Guidelines (GWTG)-Stroke program in the United States, from 2009 to 2011.
  
  
  METHODS
  12,552 warfarin naive atrial fibrillation patients admitted to hospital for ischemic stroke and treated with warfarin compared with no oral anticoagulant at discharge, linked to Medicare claims for longitudinal outcomes.
  
  
  METHODS
  Major adverse cardiovascular events (MACE) and home time, a patient centered outcomes measure defined as the total number of days free from institutional care after discharge. A propensity score inverse probability weighting method was used to account for all differences in observed characteristics between treatment groups.
  
  
  RESULTS
  Among 12,552 survivors of stroke, 11,039 (88%) were treated with warfarin at discharge. Warfarin treated patients were slightly younger and less likely to have a history of previous stroke or coronary artery disease but had similar severity of stroke as measured by the National Institutes of Health Stroke Scale. Relative to those not treated, patients treated with warfarin had more days at home (as opposed to institutional care) during the two years after discharge (adjusted home time difference 47.6 days, 99% confidence interval 26.9 to 68.2). Patients discharged on warfarin treatment also had a reduced risk of MACE (adjusted hazard ratio 0.87, 99% confidence interval 0.78 to 0.98), all cause mortality (0.72, 0.63 to 0.84), and recurrent ischemic stroke (0.63, 0.48 to 0.83). These differences were consistent among clinically relevant subgroups by age, sex, stroke severity, and history of previous coronary artery disease and stroke.
  
  
  CONCLUSIONS
  Among ischemic stroke patients with atrial fibrillation, warfarin treatment was associated with improved long term clinical outcomes and more days at home. Clinical trial registration Clinical trials NCT02146274.
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA ying.xian@duke.edu.
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Wu
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA.
authors.forename: Emily C
authors.initials: EC
authors.lastname: O'Brien
authors.affiliation: Division of Cardiology, University of California, Los Angeles, CA, USA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Department of Neurology and Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: DaiWai M
authors.initials: DM
authors.lastname: Olson
authors.affiliation: Stroke Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.affiliation: Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.affiliation: The American Heart Association and University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Suter
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA Division of Cardiology, University of California, Los Angeles, CA, USA Department of Neurology and Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA Stroke Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada The American Heart Association and University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Deidre
authors.initials: D
authors.lastname: Hannah
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA Division of Cardiology, University of California, Los Angeles, CA, USA Department of Neurology and Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA Stroke Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada The American Heart Association and University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Brianna
authors.initials: B
authors.lastname: Lindholm
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA Division of Cardiology, University of California, Los Angeles, CA, USA Department of Neurology and Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA Stroke Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada The American Heart Association and University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Lesley
authors.initials: L
authors.lastname: Maisch
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Greiner
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA.
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Lytle
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, USA.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin