The various risk stratification schemes classified variable proportions as low , moderate and high risk , but the CHA(2)DS(2)-VASc score classified the smallest proportion of patients as ' low risk ' .
Anticoagulation with vitamin K antagonists and dabigatran is cost-effective in patients at high risk of stroke , but not in patients without any other stroke risk factor beside AF .
Cost Effectiveness of Warfarin Versus Aspirin in Patients Older Than 75 Years With Atrial Fibrillation
Background and Purpose — Oral anticoagulants are effective at reducing stroke compared with aspirin in atrial fibrillation patients older than 75 years . Although the benefits of reduced stroke risk outweigh the risks of bleeding , the cost effectiveness of warfarin in this patient population has not yet been established . Methods — An economic evaluation was conducted alongside a r and omized , controlled trial ; 973 patients ≥75 years of age with atrial fibrillation were recruited from primary care and r and omly assigned to either take warfarin or aspirin . Follow-up was for a mean of 2.7 years . Costs of thrombotic and hemorrhagic events , anticoagulation clinic visits , and primary care utilization were determined . Clinical benefits were expressed in terms of a primary event avoided : fatal/nonfatal disabling stroke , intracranial hemorrhage , or systemic embolism . A cost-utility analysis was performed using quality -adjusted life years as the benefit measure . Results — Total costs over 4 years were lower in the warfarin group ( difference , −£165 ; 95 % CI , −£452–£89 ) , primarily driven by the difference in primary event costs . The primary event rate over 4 years was lower in the warfarin group ( 0.049 versus 0.099 ) , and the quality -adjusted life years score was higher ( difference , 0.02 ; 95 % CI , −0.07–0.11 ) . With lower costs and a higher quality -adjusted life years score , warfarin is the dominant treatment , but the differences in both costs and effects are small . Conclusions — Warfarin is cost-effective compared with aspirin in atrial fibrillation patients age ≥75 years . These data support the anticoagulant therapy option in this high-risk patient population . However , the small differences in costs and effects indicate the importance of exploring patient preferences
The various risk stratification schemes classified variable proportions as low , moderate and high risk , but the CHA(2)DS(2)-VASc score classified the smallest proportion of patients as ' low risk ' .
Anticoagulation with vitamin K antagonists and dabigatran is cost-effective in patients at high risk of stroke , but not in patients without any other stroke risk factor beside AF .