This article is more than 5 years old. Information may no longer be current.
Warfarin reinitiation after major GI bleeding improved survival
Click Here to Manage Email Alerts
Patients with atrial fibrillation who restarted anticoagulation therapy shortly after a major gastrointestinal bleeding episode had improved survival and reduced thromboembolism risk without increased risk for recurrent bleeding, according to results from a retrospective cohort study.
Researchers evaluated 1,329 patients (mean age, 76 years; 45% women) who developed major gastrointestinal (GI) bleeding during treatment with warfarin for nonvalvular AF between 2005 and 2010. All patients had received treatment at the anticoagulation clinic of the Henry Ford Health System.
Warfarin was restarted in 653 patients (49.1%) after treatment was interrupted due to the bleeding. The median treatment interruption among these patients was 50 days.
During 2 years of follow-up, 463 patients died, and 221 participants experienced thromboembolism within 1 year of warfarin interruption. Patients who restarted warfarin had a lower risk for death (HR=0.67; 95% CI, 0.56-0.81) and thromboembolism (HR=0.71; 95% CI, 0.54-0.93) but similar risk for recurrent GI bleeding (HR=1.18; 95% CI, 0.94-1.1) compared with patients who did not reinitiate warfarin.
Stratification according to duration of warfarin interruption indicated a trend toward reduced thromboembolism risk when therapy was reinitiated after 7 to 15 days (HR=0.48; 95% CI, 0.2-1.15) and a trend toward increased risk among those who did not reinitiate therapy (HR=1.35; 95% CI, 0.97-1.89) vs. patients who reinitiated therapy after more than 30 days.
Reinitiation of warfarin after an interruption of up to 21 days was associated with decreased mortality risk, without increased risk for recurrent bleeding, when compared with an interruption of longer than 30 days. However, patients who interrupted treatment for less than 7 days had a significantly higher bleeding risk (HR=3.27; 95% CI, 1.82-5.91) than patients who interrupted treatment for longer than 30 days.
“The study … demonstrated that lower risks of thromboembolism and mortality were associated with resuming anticoagulation,” the researchers wrote. “… Interrupting warfarin may lead to an increase in short-term risk of thromboembolism. This may have clinical implications, especially if further research shows that early resumption of warfarin leads to better outcomes.”
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts