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Warfarin Use among Ambulatory Patients with Nonvalvular Atrial Fibrillation: The AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study

Alan S. Go, MD; Elaine M. Hylek, MD, MPH; Leila H. Borowsky, MPH; Kathleen A. Phillips, BA; Joe V. Selby, MD, MPH; and Daniel E. Singer, MD
[+] Article and Author Information

From Kaiser Permanente Medical Care Program (Northern California), Oakland, and University of California at San Francisco, San Francisco, California; and Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.


Acknowledgments: The authors thank Vernal Mason and Lori E. Henault for helping to coordinate this project and for technical support.

Grant Support: By Public Health Services research grant AG15478 from the National Institute on Aging.

Requests for Reprints: Alan S. Go, MD, Division of Research, Kaiser Permanente Medical Care Program (Northern California), 3505 Broadway Street, 12th Floor, Oakland, CA 94611-5714; e-mail, axg@dor.kaiser.org. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Dr. Go and Ms. Phillips: Division of Research, Kaiser Permanente Medical Care Program (Northern California), 3505 Broadway Street, 12th Floor, Oakland, CA 94611-5714.

Drs. Hylek and Singer and Ms. Borowsky: Medical Practices Evaluation Unit, 50 Staniford Street, 9th Floor, Boston, MA 02114.

Dr. Selby: Division of Research, 3505 Broadway Street, 13th Floor, Oakland, CA 94611.


Ann Intern Med. 1999;131(12):927-934. doi:10.7326/0003-4819-131-12-199912210-00004
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Atrial fibrillation is the most common, potent risk factor for ischemic stroke. Nonrheumatic atrial fibrillation, the predominant form in the United States, occurs in nearly 6% of persons 65 years of age or older (1). Atrial fibrillation is an independent risk factor for stroke, increasing the annual risk by fivefold and accounting for approximately 15% of all strokes in the United States (2). Over the past decade, multiple randomized trials have demonstrated that warfarin therapy can reduce the average annual risk for ischemic stroke by two thirds, from 4.5% to 1.4%, in patients with nonvalvular atrial fibrillation (2). This benefit was accompanied by a relatively low annual bleeding rate (1.3%) (24). However, recent data suggest that these dramatic findings have not been adequately implemented in clinical practice (59).

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Figure 1.
Prevalent warfarin use by age among 11 082 ambulatory patients with nonvalvular atrial fibrillation and no identified contraindications to warfarin therapy.

Numbers in parentheses represent the number of patients in the denominator of each category. Error bars represent upper 95% confidence limits.

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Figure 2.
Prevalence of warfarin use by number of risk factors for stroke (11 082 patients) and identified contraindications to warfarin (13 428 patients) among patients with nonvalvular atrial fibrillation.

Clinical risk factors for stroke other than increased age (≥ 65 years) were previous known ischemic stroke, congestive heart failure, and hypertension. Contraindications to therapy were previous intracranial hemorrhage, previous gastrointestinal hemorrhage, previous other hemorrhage, mechanical fall, dementia, seizure history, cirrhosis or hepatitis, or renal insufficiency. Numbers in parentheses represent the numbers of patients in the denominator of each category. Error bars represent upper 95% confidence limits.

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Summary for Patients

Blood Thinner Use in Patients with Atrial Fibrillation

The summary below is from the full report titled “Warfarin Use among Ambulatory Patients with Nonvalvular Atrial Fibrillation: The AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.” It is in the 12 December 1999 issue of Annals of Internal Medicine (volume 131, pages 927-934). The authors are A.S. Go, E.M. Hylek, L.H. Borowsky, K.A. Phillips, J.V. Selby, and D.E. Singer.

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