Warfarin use is increasing - does that mean there is going to an increase in the intracranial bleeds in clinical practice?
In a recent study from Finland, it was shown there was increased use of warfarin to prevent thrombotic episodes ( atrial fibrillation) there was no corresponding increase in the intracranial bleeds.
Effect of Increased Warfarin Use on Warfarin-Related Cerebral Hemorrhage
Juha Huhtakangas, MD , A Longitudinal Population-Based Study
Results—The proportion of warfarin users among the population increased 3.6-fold from 0.68% in 1993 to 2.28% in 2008. Of a total of 982 patients with ICH, 182 (18.5%) had warfarin-related ICH. One-year survival rate after onset of stroke was 35.2% among warfarin users and 67.9% among nonusers. The annual incidence (P=0.062) and 28-day case fatality of warfarin-related ICHs (P=0.002) decreased during the observation period. Warfarin users were older (mean difference 6.6; 95% CI, 5.0 to 8.1; P<0.001) than nonusers. Admission international normalized ratio values above the therapeutic range (2.0 to 3.0) decreased through the observation period, suggesting improved control of anticoagulant therapy over time. Conclusions—The annual incidence and case fatality of warfarin-related ICHs decreased, although the proportion of warfarin users almost quadrupled in our population.
In a recent study from Finland, it was shown there was increased use of warfarin to prevent thrombotic episodes ( atrial fibrillation) there was no corresponding increase in the intracranial bleeds.
Effect of Increased Warfarin Use on Warfarin-Related Cerebral Hemorrhage
Juha Huhtakangas, MD , A Longitudinal Population-Based Study
Results—The proportion of warfarin users among the population increased 3.6-fold from 0.68% in 1993 to 2.28% in 2008. Of a total of 982 patients with ICH, 182 (18.5%) had warfarin-related ICH. One-year survival rate after onset of stroke was 35.2% among warfarin users and 67.9% among nonusers. The annual incidence (P=0.062) and 28-day case fatality of warfarin-related ICHs (P=0.002) decreased during the observation period. Warfarin users were older (mean difference 6.6; 95% CI, 5.0 to 8.1; P<0.001) than nonusers. Admission international normalized ratio values above the therapeutic range (2.0 to 3.0) decreased through the observation period, suggesting improved control of anticoagulant therapy over time. Conclusions—The annual incidence and case fatality of warfarin-related ICHs decreased, although the proportion of warfarin users almost quadrupled in our population.
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