The Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation
Authors: Daniel E. Singer
Journal: Annals of Internal Medicine (2010)

Letters16 February 2010The Net Clinical Benefit of Warfarin Anticoagulation in Atrial FibrillationDaniel E. Singer, MD, Yuchiao Chang, PhD, and Alan S. Go, MDDaniel E. Singer, MDFrom Massachusetts General Hospital, Boston, MA 02114; and Kaiser Permanente of Northern California, Oakland, CA 94612-2304.Search for more papers by this author, Yuchiao Chang, PhDFrom Massachusetts General Hospital, Boston, MA 02114; and Kaiser Permanente of Northern California, Oakland, CA 94612-2304.Search for more papers by this author, and Alan S. Go, MDFrom Massachusetts General Hospital, Boston, MA 02114; and Kaiser Permanente of Northern California, Oakland, CA 94612-2304.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-4-201002160-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We support Dr. Bussey's emphasis on the importance of maximizing TTR. The benefits and risks of warfarin therapy in atrial fibrillation are strongly dependent on maintaining the INR in the optimum range (1, 2). That is why we reported the overall TTR, 65%, for our ATRIA (AnTicoagulation and Risk Factors In Atrial Fibrillation) cohort. At lower TTR values, the expected net clinical benefit will be lower, and at higher TTR values, the net clinical benefit will increase regardless of clinical risk category as long as the distribution of out-of-range values does not change markedly. As pointed out, having ...References1. Singer DE, Chang Y, Fang MC, Borowsky LH, Pomernacki NK, Udaltsova N, et al. Should patient characteristics influence target anticoagulation intensity for stroke prevention in nonvalvular atrial fibrillation?: the ATRIA study. Circ Cardiovasc Qual Outcomes. 2009;2:297-304. [PMID: 20031854] CrossrefMedlineGoogle Scholar2. Connolly SJ, Pogue J, Eikelboom J, Flaker G, Commerford P, Franzosi MG, et al; ACTIVE W Investigators. Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of international normalized ratio control achieved by centers and countries as measured by time in therapeutic range. Circulation. 2008;118:2029-37. [PMID: 18955670] CrossrefMedlineGoogle Scholar3. Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmaurice D, Lip GY, et al; BAFTA investigators. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet. 2007;370:493-503. [PMID: 17693178] CrossrefMedlineGoogle Scholar4. Fang MC, Go AS, Chang Y, Borowsky L, Pomernacki NK, Singer DE; ATRIA Study Group. Comparison of risk stratification schemes to predict thromboembolism in people with nonvalvular atrial fibrillation. J Am Coll Cardiol. 2008;51:810-5. [PMID: 18294564] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Daniel E. Singer, MD; Yuchiao Chang, PhD; Alan S. Go, MDAffiliations: From Massachusetts General Hospital, Boston, MA 02114; and Kaiser Permanente of Northern California, Oakland, CA 94612-2304.Disclosures:Consultancies: D.E. Singer (AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Johnson & Johnson, Merck, Sanofi-Aventis). Honoraria: D.E. Singer (Bristol-Myers Squibb, Pfizer). Grants received: D.E. Singer (Daiichi Sankyo), A.S. Go (Johnson & Johnson). 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 The Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation Henry Bussey The Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation Vikram Budhraja Metrics Cited byMeta-analysis of Safety and Efficacy of Anticoagulation versus no Anticoagulation in Octogenarians and Nonagenarians with Atrial Fibrillation 16 February 2010Volume 152, Issue 4 Page: 265 Keywords Atrial fibrillation Genetic testing International normalized ratio Ischemic stroke Medical risk factors Motivation Population statistics Randomized trials Relative risk Risk management ePublished: 16 February 2010 Issue Published: 16 February 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...