The Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation
Authors: Henry Bussey
Journal: Annals of Internal Medicine (2010)

Letters16 February 2010The Net Clinical Benefit of Warfarin Anticoagulation in Atrial FibrillationHenry Bussey, PharmDHenry Bussey, PharmDFrom The University of Texas at Austin, Austin, TX 78712.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-4-201002160-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:With regard to the article by Singer and colleagues (1), calculating net clinical benefit of warfarin therapy in atrial fibrillation is an important concept (2). However, 3 other issues should be considered in the future.First, warfarin therapy affects other major events and may substantially reduce myocardial infarction and death (3).Second, because control of the international normalized ratio (INR) varies in different settings and because a 10% improvement in the amount of time the INR is in the therapeutic range (TTR) has been associated with a greater than 10% reduction in event rates (3, 4), the ...References1. Singer DE, Chang Y, Fang MC, Borowsky LH, Pomernacki NK, Udaltsova N, et al. The net clinical benefit of warfarin anticoagulation in atrial fibrillation. Ann Intern Med. 2009;151:297-305. [PMID: 19721017] LinkGoogle Scholar2. Hart RG, Halperin JL. Do current guidelines result in overuse of warfarin anticoagulation in patients with atrial fibrillation? [Editorial]. Ann Intern Med. 2009;151:355-6. [PMID: 19721024] LinkGoogle Scholar3. White HD, Gruber M, Feyzi J, Kaatz S, Tse HF, Husted S, et al. Comparison of outcomes among patients randomized to warfarin therapy according to anticoagulant control: results from SPORTIF III and V. Arch Intern Med. 2007;167:239-45. [PMID: 17296878] CrossrefMedlineGoogle Scholar4. Jones M, McEwan P, Morgan CL, Peters JR, Goodfellow J, Currie CJ. Evaluation of the pattern of treatment, level of anticoagulation control, and outcome of treatment with warfarin in patients with non-valvar atrial fibrillation: a record linkage study in a large British population. Heart. 2005;91:472-7. [PMID: 15772203] CrossrefMedlineGoogle Scholar5. Veeger NJ, Piersma-Wichers M, Hillege HL, Crijns HJ, van der Meer J. Early detection of patients with a poor response to vitamin K antagonists: the clinical impact of individual time within target range in patients with heart disease [Letter]. J Thromb Haemost. 2006;4:1625-7. [PMID: 16839366] CrossrefMedlineGoogle Scholar6. Harper PL, Pollock D. Anticoagulation self-management using near patient testing and decision support software provided via an Internet Website improved anticoagulation control in patients on long-term warfarin [Abstract]. Blood. 2008;112:1278. CrossrefGoogle Scholar7. Bussey HI, Walker MB, Bussey-Smith KL, Frei CR. Interim analysis of triple intervention to improve the international normalized ratio (INR) in warfarin-treated patients [Abstract]. Presented at the International Society of Thrombosis and Haemostasis Congress, Boston, Massachusetts, 11–16 July 2009. Accessed at isth2009.com/abstract_submission.html on 8 January 2010. Abstract no. PP-MO-469. Google Scholar Author, Article, and Disclosure InformationAffiliations: From The University of Texas at Austin, Austin, TX 78712.Disclosures:Consultancies: Genesis Advanced Technologies. Stock ownership or options (other than mutual funds): Inverness Medical. Patents received/pending: 3 vitamin K antagonist products. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation Daniel E. Singer , Yuchiao Chang , Margaret C. Fang , Leila H. Borowsky , Niela K. Pomernacki , Natalia Udaltsova , and Alan S. Go Do Current Guidelines Result in Overuse of Warfarin Anticoagulation in Patients With Atrial Fibrillation? Robert G. Hart and Jonathan L. Halperin The Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation Vikram Budhraja The Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation Daniel E. Singer , Yuchiao Chang , and Alan S. Go Metrics Cited byComparison of HAS-BLED with other risk models for predicting the bleeding risk in anticoagulated patients with atrial fibrillation 16 February 2010Volume 152, Issue 4Page: 264-265KeywordsAtrial fibrillationComputersConflicts of interestForecastingHemorrhageMyocardial infarctionVitamin K ePublished: 16 February 2010 Issue Published: 16 February 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...