Anticoagulation therapy for cardioembolic stroke prevention in the elderly: Defining benefits and risks

Aging Health

Volumn 6, Issue 4, 2010, Pages 439-450

  Freeman, William D ^a,b   Aguilar, Maria ^a  

^a MAYO CLINIC   (United States)

^b MAYO CLINIC   (United States)

Author keywords

anticoagulation; atrial fibrillation; cardioembolic stroke; elderly

Indexed keywords

ACETYLSALICYLIC ACID; ANTICOAGULANT AGENT; ANTITHROMBOCYTIC AGENT; CLOPIDOGREL; COUMARIN; DABIGATRAN; DIPYRIDAMOLE; IRBESARTAN; PERINDOPRIL; PLACEBO; TICLOPIDINE; WARFARIN; XIMELAGATRAN;

AGING; ANTICOAGULANT THERAPY; BLEEDING; BRAIN EMBOLISM; BRAIN HEMORRHAGE; BRAIN ISCHEMIA; CARDIOMYOPATHY; CEREBROVASCULAR ACCIDENT; CONGESTIVE HEART FAILURE; DEEP VEIN THROMBOSIS; DIABETES MELLITUS; DIGESTIVE SYSTEM HEMORRHAGE; DRUG CONTRAINDICATION; DRUG INDICATION; DRUG SAFETY; DRUG WITHDRAWAL; GASTROINTESTINAL HEMORRHAGE; HEART ATRIUM FIBRILLATION; HIGH RISK PATIENT; HUMAN; HYPERCOAGULABILITY; HYPERTENSION; INTERNATIONAL NORMALIZED RATIO; INTRACARDIAC THROMBOSIS; MITRAL VALVE STENOSIS; OCCLUSIVE CEREBROVASCULAR DISEASE; PRACTICE GUIDELINE; PREDICTION; REVIEW; RISK BENEFIT ANALYSIS; RISK REDUCTION; THROMBOEMBOLISM; TRANSIENT ISCHEMIC ATTACK; URINARY TRACT HEMORRHAGE; VALVULAR HEART DISEASE;

EID: 77956164483     PISSN: 1745509X     EISSN: 17455103     Source Type: Journal    
DOI: 10.2217/ahe.10.45     Document Type: Review

References (78)

1. Kresge N, Simoni RD, Hill RL: Hemorrhagic sweet clover disease, dicumarol and warfarin: the work of Karl Paul Link. J. Biol. Chem. 280, e5 (2005).
2. Stahmann MA, Huebner CF, Link KP: Studies on the hemorrhagic sweet clover disease: V. Identifcation and synthesis of the hemorrhagic agent J. Biol. Chem. 138, 513-527 (1941).
3. Hart RG, Pearce LA, Aguilar MI: Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular AF. Ann. Intern. Med. 146, 857-867 (2007).
4. Peterson GM, Boom K, Jackson SL, Vial JH: Doctors' beliefs on the use of antithrombotic therapy in AF: identifying barriers to stroke prevention. Int. Med. J. 32, 15-23 (2002).
5. Aguilar MI, Hart RG, Kase CS et al.: Treatment of warfarin-associated intracerebral hemorrhage: literature review and expert opinion. Mayo Clin. Proc. 82, 82-92 (2007).
6. Phan TG, Wijdicks EF: Management of intracranial bleeding associated with anticoagulation: balancing the risk of further bleeding against thromboembolism from prosthetic heart valves. J. Neurol. Neurosurg. Psychiatr. 70, 820-821 (2001).
7. Go AS, Hylek EM, Phillips KA et al.: Prevalence of diagnosed AF in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. JAMA 285, 2370-2375 (2001).
8. Fuster V, Ryden LE, Asinger RW et al.: ACC/AHA/ESC guidelines for the management of patients with AF: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the North American Society of Pacing and Electrophysiology. J. Am. Coll. Cardiol. 38, 1231-1266 (2001).
9. Risk factors for stroke and effcacy of antithrombotic therapy in AF. Analysis of pooled data from fve randomized controlled trials. Arch. Int. Med. 154, 1449-1457; erratum 154(19), 2254 (1994).
10. Active Writing Group on behalf of the ACTIVE Investigators: Clopidogrel plus aspirin versus oral anticoagulation for AF in the Atrial fbrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet 367, 1903-1912 (2006).
11. Hohnloser SH, Pajitnev D, Pogue J, Healey JS: Incidence of stroke in paroxysmal versus sustained AF in patients taking oral anticoagulation or combined antiplatelet therapy: an ACTIVE W substudy. J. Am. Coll. Cardiol. 50, 2156-2216 (2007).
12. Hart RG: Atrial fbrillation and stroke prevention. N. Engl. J. Med. 349, 1015-1016 (2003).
13. Optimal oral anticoagulant therapy in patients with nonrheumatic AF and recent cerebral ischemia. The European Atrial Fibrillation Trial Study Group. N. Engl. J. Med. 333, 5-10 (1995).
14. Aguilar MI, Hart RG, Pearce L: Oral anticoagulants versus antiplatelet therapy for preventing stroke in patients with non-valvular AF and no history of stroke or transient ischemic attacks. Cochrane Database Syst. Rev. (3), CD006186 (2007).
15. Warfarin versus aspirin for prevention of thromboembolism in AF: Stroke Prevention in Atrial Fibrillation II Study. Lancet 343, 687-691 (1994).
16. Fang MC, Stafford RS, Ruskin JN, Singer DE: National trends in antiarrhythmic and antithrombotic medication use in AF. Arch. Int. Med. 164, 55-60 (2004).
17. Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM: Prevalence of AF in elderly subjects (the Cardiovascular Health study). Am. J. Cardiol. 74, 236-241 (1994).
18. Hart RG, Benavente O, McBride R, Pearce LA: Antithrombotic therapy to prevent stroke in patients with AF: a meta-analysis. Ann. Int. Med. 131, 492-501 (1999).
19. Linkins LA, Choi PT, Douketis JD: Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta-analysis. Ann. Int. Med. 139, 893-900 (2003).
20. Van Walraven C, Hart RG, Singer DE et al.: Oral anticoagulants vs aspirin in nonvalvular AF: an individual patient meta-analysis. JAMA 288, 2441-2448 (2002).
21. Mant J, Hobbs FD, Fletcher K et al.: Warfarin versus aspirin for stroke prevention in an elderly community population with AF (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 370, 493-503 (2007).
22. Singer DE, Chang Y, Fang MC et al.: Net clinical beneft of warfarin anticoagulation in AF. Ann. Intern. Med. 151, 297-305 (2009).
23. American Geriatrics Society Clinical Practice Committee: The use of oral anticoagulants (warfarin) in older people. J. Am. Geriatr. Soc. 50, 1439-1445 (2002).
24. Fang MC, Go AS, Chang Y et al.: Comparison of risk stratifcation schemes to predict thromboembolism in people with nonvalvular AF. J. Am. Coll. Cardiol. 51, 810-815 (2008).
25. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ: Validation of clinical classifcation schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 285, 2864-2870 (2001).
26. Hart RG: What causes intracerebral hemorrhage during warfarin therapy? Neurology 55, 907-908 (2000).
27. Hart RG, Tonarelli SB, Pearce LA: Avoiding central nervous system bleeding during antithrombotic therapy: recent data and ideas. Stroke 36, 1588-1593 (2005).
28. Albers GW, Diener HC, Frison L et al.: Ximelagatran vs warfarin for stroke prevention in patients with nonvalvular AF: a randomized trial. JAMA 293, 690-698 (2005).
29. Freeman WD, Aguilar MI: Stroke prevention in AF and other major cardiac sources of embolism. Neurol. Clin. 26, 1129-1160 (2008).
30. Connolly SJ, Ezekowitz MD, Yusuf S et al.; RE-LY Steering Committee and Investigators: Dabigatran versus warfarin in patients with AF. N. Engl. J. Med. 361, 1139-1151 (2009).
31. Schwartz NE, Albers GW: Dabigatran challenges warfarin's superiority for stroke prevention in AF. Stroke 41, 1307-1309 (2010).
32. Connolly SJ, Pogue J, Hart R et al.: Effect of clopidogrel added to aspirin in patients with AF. N. Engl. J. Med. 360, 2066-2078 (2009).
33. Hirsh J, Guyatt G, Albers GW, Harrington R, Schünemann HJ: Antithrombotic and thrombolytic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133, 110S-112S (2008).
34. American College of Cardiology, American Heart Association Task Force on Practice, American Society of Cardiovascular et al.: ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J. Am. Coll. Cardiol. 48, E1-E148 (2006); erratum 49(9), 1014 (2007).
35. Stein PD, Alpert JS, Dalen JE, Horstkotte D, Turpie AG: Antithrombotic therapy in patients with mechanical and biological prosthetic heart valves. Chest 114, 602S-610S (1998).
36. Fang MC, Chang Y, Hylek EM et al.: Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for A F. Ann. Intern. Med. 141(10), 745-752 (2004).
37. Charcot JM, Bouchard C: Nouvelles recherchers sur la pathogenie de ĺhémorragie cerébrale. Arch. Physiol. Norm. Pathol. 1, 643-645 (1868).
38. Fisher CM: Pathological observations in hypertensive cerebral hemorrhage. J. Neuropath. Exp. Neurol. 30, 536-550 (1971).
39. Garcia JH, Ho KL: Pathology of hypertensive arteriopathy. Neurosurg. Clin. North Am. 3, 497-507 (1992).
40. Viswanathan A, Chabriat H: Cerebral microhemorrhage. Stroke 37, 550-555 (2006).
41. Smith EE, Rosand J, Knudsen KA, Hylek EM, Greenberg SM: Leukoaraiosis is associated with warfarin-related hemorrhage following ischemic stroke. Neurology 59, 193-197 (2002).
42. Hylek EM, Singer DE: Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann. Intern. Med. 120, 897-902 (1994).
43. Roob G, Lechner A, Schmidt R, Flooh E, Hartung HP, Fazekas F: Frequency and location of microbleeds in patients with primary intracerebral hemorrhage. Stroke 31, 2665-2669 (2000).
44. Sjoblom L, Hardemark HG, Lindgren A et al.: Management and prognostic features of intracerebral hemorrhage during anticoagulant therapy: a Swedish multicenter study. Stroke 32, 2567-2574 (2001).
45. Ansell J, Hirsh J, Hylek E et al.: Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133, 160S-198S (2008).
46. Broderick J, Connolly S, Feldmann E et al.: Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke 38, 2001-2023 (2007).
47. Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G: Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke 24, 987-993 (1993).
48. Mayer SA, Brun NC, Begtrup K et al.: Effcacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage. N. Engl. J. Med. 358, 2127-2137 (2008).
49. Rosand J, Eckman MH, Knudsen KA, Singer DE, Greenberg SM: The effect of warfarin and intensity of anticoagulation on outcome of intracerebral hemorrhage. Arch. Intern. Med. 164, 880-884 (2004).
50. Fihn SD, Callahan CM, Martin DC, McDonell MB, Henikoff JG, White RH: The risk for and severity of bleeding complications in elderly patients treated with warfarin. The National Consortium of Anticoagulation Clinics. Ann. Int. Med. 124, 970-979 (1996).
51. Gorter JW: Major bleeding during anticoagulation after cerebral ischemia: patterns and risk factors. Stroke Prevention in Reversible Ischemia Trial (SPIRIT). European Atrial Fibrillation Trial (EAFT) study groups. Neurology 53, 1319-1327 (1999).
52. Landefeld CS, Beyth RJ: Anticoagulant-related bleeding: clinical epidemiology, prediction, and prevention. Am. J. Med. 95, 315-328 (1993).
53. Man-Son-Hing M, Laupacis A: Balancing the risks of stroke and upper gastrointestinal tract bleeding in older patients with AF. Arch. Int. Med. 162, 541-550 (2002).
54. Palareti G, Hirsh J, Legnani C et al.: Oral anticoagulation treatment in the elderly: a nested, prospective, case-control study. Arch. Int. Med. 160, 470-478 (2000).
55. Palareti G, Leali N, S Coccheri et al.: Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Italian Study on Complications of Oral Anticoagulant Therapy. Lancet 348, 423-428 (1996).
56. Olsson SB: Stroke prevention with the oral direct thrombin inhibitor ximelagatran compared with warfarin in patients with non-valvular AF (SPORTIF III): randomised controlled trial. Lancet 362, 1691-1698 (2003).
57. Hittelet A, Deviere J: Management of anticoagulants before and after endoscopy. Can. J. Gastroenterol. 17, 329-332 (2003).
58. Rubin TA, Murdoch M, Nelson DB: Acute GI bleeding in the setting of supratherapeutic international normalized ratio in patients taking warfarin: endoscopic diagnosis, clinical management, and outcomes. Gastrointest. Endosc. 58, 369-373 (2003).
59. Hashash JG, Shamseddeen W, Skoury A, Aoun N, Barada K: Gross lower gastrointestinal bleeding in patients on anticoagulant and/or antiplatelet therapy: endoscopic fndings, management, and clinical outcomes. J. Clin. Gastroenterol. 43(1), 36-42 (2009).
60. Christensen K, Doblhammer G, Rau R, Vaupel JW: Ageing populations: the challenges ahead. Lancet 374, 1196-1208 (2009).
61. Khan TI, Kamali F, Kesteven P et al.: The value of education and self-monitoring in the management of warfarin therapy in older patients with unstable control of anticoagulation. Brit. J. Haematol. 126(4), 557-564 (2004
62. Ryan F, Byrne S, O'Shea S: Managing oral anticoagulation therapy: improving clinical outcomes. A review. J. Clin. Pharm. Ther. 33, 581-590 (2008).
63. Moyer TP, O'Kane DJ, LM Baudhuin et al.: Warfarin sensitivity genotyping: a reviewof the literature and summary of patient experience. Mayo Clin. Proc. 84, 1079-1094 (2009).
64. Gage BF, Yan Y, Milligan PE et al.: Clinical classifcation schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am. Heart J. 151, 713-719 (2006).
65. Chang Y, Cortellini L, Greenberg SM et al.; Genes for Cerebral Hemorrhage on Anticoagulation Collaborative Group: Exploiting common genetic variation to make anticoagulation safer. Stroke 40, S64-S66 (2009).
66. Chapman N, Huxley R, Anderson C et al.: Effects of a perindopril-based blood pressure-lowering regimen on the risk of recurrent stroke according to stroke subtype and medical history: the PROGRESS Trial. Stroke 35, 116-121 (2004).
67. Gage BF, Birman-Deych E, Kerzner R, Radford MJ, Nilasena DS, Rich MW: Incidence of intracranial hemorrhage in patients with AF who are prone to fall. Am. J. Med. 118, 612-617 (2005).
68. Jacobs LG, Billett HH, Freeman K, Dinglas C, Jumaquio L: Anticoagulation for stroke prevention in elderly patients with AF, including those with falls and/or early-stage dementia: a single-center, retrospective, observational study. Am. J. Geriatr. Pharmacother. 7, 159-166 (2009).
69. Di Tullio MR, Homma S: Mechanisms of cardioembolic stroke. Curr. Cardiol. Rep. 4, 141-148 (2002).
70. Loh E, Sutton MS, Wun CC et al.: Ventricular dysfunction and the risk of stroke after myocardial infarction. N. Engl. J. Med. 336, 251-257 (1997).
71. Koniaris LS, Goldhaber SZ: Anticoagulation in dilated cardiomyopathy. J. Am. Coll. Cardiol. 31, 745-748 (1998).
72. Massie BM, Krol WF, Ammon SE et al.: The Warfarin and Antiplatelet Therapy in Heart Failure trial (WATCH): rationale, design, and baseline patient characteristics. J. Card. Fail. 10(2), 101-112 (2004).
73. Massie BM, Krol WF, Ammon SE et al.: The Warfarin and Antiplatelet Therapy in Heart Failure trial (WATCH): rationale, design, and baseline patient characteristics. [see comment]. J. Card. Fail. 10, 101-112 (2004).
74. Pullicino P, Thompson JL, Barton B et al.: Warfarin versus aspirin in patients with reduced cardiac ejection fraction (WARCEF): rationale, objectives, and design. J. Card. Fail. 12, 39-46 (2006).
75. Witt BJ, Brown RD Jr, Jacobsen SJ et al.: Ischemic stroke after heart failure: a community-based study. Am. Heart J. 152, 102-109 (2006).
76. Messe SR, Silverman IE, Kizer JR et al.: Practice parameter: recurrent stroke with patent foramen ovale and atrial septal aneurysm: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 62, 1042-1050 (2004).
77. Bos MJ, Koudstaal PJ, Hofman A, Breteler MM: Decreased glomerular fltration rate is a risk factor for hemorrhagic but not for ischemic stroke: the Rotterdam Study. Stroke 38, 3127-3132 (2007).
78. Chen Y W, Gurol ME, Rosand J et al.: Progression of white matter lesions and hemorrhages in cerebral amyloid angiopathy. Neurology 67, 83-87 (2006).