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Summaries for Patients |16 October 2018

Stroke Rates, Atrial Fibrillation, and Drugs to Prevent Blood Clots Free

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published at Annals.org on 25 September 2018.

  • From: Shah SJ, Eckman MH, Aspberg S, Go AS, Singer DE. Effect of variation in published stroke rates on the net clinical benefit of anticoagulation for atrial fibrillation. Ann Intern Med. 2018;169:517-27. doi:10.7326/M17-2762


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What is the problem and what is known about it so far?

People who have a particular type of irregular heart rate known as atrial fibrillation are more likely to have strokes than people without this abnormality. Most of the strokes are caused by blood clots in the brain. Drugs that slow down clotting can reduce the risk for stroke in many of these people. But these drugs can also cause extra bleeding, including severe bleeding and death. The goal is to use these drugs when the benefit from stroke prevention is greater than the harm from extra bleeding.

Why did the researchers do this particular study?

The benefit from stroke prevention depends on how many strokes people have without the drugs and how effective the drugs are at reducing the number of strokes. We have a pretty good idea about how effective the drugs are, but we know less about how many strokes people have without the drugs. Different studies have reported different results. For the same patients, some studies report high stroke risk without drugs and others report low stroke risk without drugs. The researchers of this study wanted to find out if different stroke risks might affect the decision to use these drugs.

Who was studied?

Thousands of people who had just been diagnosed with atrial fibrillation.

How was the study done?

Using a computer simulation, the researchers calculated how much benefit people would get from stroke prevention if they took drugs and how much harm they would have from extra bleeding if they took drugs. The researchers then combined the benefits and harms to identify the overall effect. They did this assuming high stroke risk and again assuming low stroke risk. The researchers then compared the overall effects using the high stroke risk with the overall effects using the low stroke risk.

What did the researchers find?

When the stroke risk without drugs is high, people get almost 4 times as much benefit as when the stroke risk without drugs is low.

What were the limitations of the study?

It is difficult to figure out the actual stroke risk for any specific person.

What are the implications of the study?

Guidelines that recommend which patients with atrial fibrillation should take drugs to slow down clotting should be modified to put more importance on a person's stroke risk in deciding if drugs will be beneficial.

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1 Comment

Burton Abrams

No institutional affiliation

September 25, 2018

Another treatment for afib

Afib is frequently a consequence of sleep apnea, as well as an increased blood coagulation propensity which makes an ischemic stroke more likely to occur. Anyone who experiences afib should undergo diagnostic testing for sleep apnea, and then follow the recommended treatment to overcome it. My experience 15 years ago was that within 6 months of overcoming my sleep apnea, my afib ceased completely and my blood coagulability reduced so much that my warfarin usage was stopped.

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Stroke Rates, Atrial Fibrillation, and Drugs to Prevent Blood Clots. Ann Intern Med. 2018;169:I–22. [Epub ahead of print 25 September 2018]. doi: https://doi.org/10.7326/P18-0014

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Published: Ann Intern Med. 2018;169(8):I-22.

DOI: 10.7326/P18-0014

Published at www.annals.org on 25 September 2018

©
2018 American College of Physicians
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