Blood-thinning drugs can help prevent
strokes in middle-aged people with an irregular heart rhythm, and now a new
report suggests that the drugs can also benefit frail, older patients who may
not be routinely considered for drug treatment.
In particular, elderly women and those who live in rural areas may be less
likely to receive stroke-preventing drugs, such as warfarin.
In the study, warfarin reduced the risk of stroke by 24% in elderly patients
with atrial fibrillation -- an irregular heart rhythm that increases the risk of
stroke. Another blood-thinning drug, aspirin, reduced the risk by about 5% in
such patients. Atrial fibrillation occurs in 2 million people in the US
annually, and causes 75,000 strokes or "mini-strokes" every year.
"Physicians have long been reluctant to use warfarin for their elderly
patients out of a fear of hemorrhage," said lead study author Dr. Brian F. Gage
in an interview with Reuters Health.
"Our results document that, barring any contraindications, we ought to be
prescribing warfarin for our octogenarian patients with atrial fibrillation.
Patients who cannot take warfarin should be treated with aspirin," Gage added.
Gage, of the Washington University School of Medicine in St. Louis,
Missouri, and colleagues looked at 463 people mostly around age 80 who had been
hospitalized with atrial fibrillation, according to a report in the April issue
of Stroke: Journal of the American Heart Association.
About one third of the patients were prescribed warfarin, 21% were given
aspirin, and 45% were receiving no blood-thinning drugs. Those over age 76,
women, and people in rural areas were less likely to receive blood thinners than
other patients. People who have to travel long distances may be less likely to
receive blood-thinning drugs because the amount of drug in the blood needs to be
frequently monitored to prevent hemorrhage.
Even among the ideal candidates, only 69% received some form of
blood-thinning therapy, according to the report.
The researchers calculate that one death or nonfatal stroke could be
prevented for each 54 patients who take aspirin for 1 year. One death or
nonfatal stroke could be prevented for each 11 patients who take warfarin for a
year.
The authors estimate that increasing the use of warfarin by 5% in the 30,000
Missouri Medicare beneficiaries hospitalized with atrial fibrillation every year
could "avert 91 deaths or hospitalizations in the subsequent year."
"In light of the overwhelming evidence that stroke can be prevented by
(blood thinners), the low use of warfarin and aspirin in Medicare beneficiaries
is disappointing and concerning," Gage and colleagues conclude.
