Well-Managed Warfarin Treatment May Offer Viable Alternative to Other Anticoagulants

According to a study published by JAMA Cardiology, the vitamin K antagonist warfarin reduces the risk of stroke by 64% and mortality by 26% in patients with nonvalvular atrial fibrillation.

Warfarin also poses an increased risk of hemorrhage and possibly intracranial bleeding. An alternative medication for this condition are non-vitamin K antagonist oral anticoagulants.

Researchers evaluated the efficacy and safety of well-managed warfarin in 40,449 patients. Patients were monitored until the end of treatment, death, or the conclusion of the study.

Researchers found mortality to occur 2.19% and intracranial bleeding occurred .44%, annually. Patients who were on an aspirin regimen had annual rates of bleeding of 3.07% and thromboembolism 4.9%.

Patients with renal failure also were found to have a higher risk of intracranial bleeding, according to the study.

"Therapy should be closely monitored in those with renal failure, concomitant aspirin use, and an individual time in therapeutic range (iTTR) less than 70%or a high international normalized ratio (INR) variability,” the study authors said in a press release. “The iTTR is a strong indicator of probability for both bleeding and thromboembolic events and should be maintained at 70%or greater."

Researchers concluded that well-managed warfarin therapy is an alternative for patients who require anticoagulant treatment since it has low complication rates and low mortality rates.