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Anticoagulation
Study Shows Impact of Age on Warfarin Treatment Safety
Although age and warfarin use have been associated with increased risk of intracranial
hemorrhage (ICH), little information exists on age-specific rates by warfarin therapy.
Researchers from Massachusetts General Hospital compared age-specific rates of ICH in a
cohort of patients with atrial fibrillation on and off warfarin. Their study found that
treatment at moderate levels of intensity has no greater risk of hemorrhage than does lower
intensity treatment. Although the risk of hemorrhage did significantly increase in patients
over 85, that risk often can be minimized by tight control of warfarin intensity.
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The research team compiled information on 170 adult atrial fibrillation patients who had
developed intracranial hemorrhage while being treated with warfarin and compared that
data to information from 744 randomly selected patients from an anticoagulation clinic who
had not developed hemorrhage during the same time period. The study groups included only
patients taking warfarin for atrial fibrillation.
In this largest study to date of individuals with atrial fibrillation, absolute rates of
ICH were low in anticoagulated patients. Rates were similar both on and off warfarin for
patients aged 80 years. Although ICH rates increased with age, age did not independently
predict short-term mortality after ICH. Therefore, the benefits of warfarin in reducing
ischemic stroke outweigh the risk of ICH, especially in the elderly population.
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