Cited by 455Atrial Fibrillation Management and OutcomesAcute Ischemic Stroke ManagementVenous Thromboembolism Diagnosis and Management

The DOI matches its Crossref record, with a small difference in title or year; 37 of the 38 references it cites were found in a registry or an index.

Net Clinical Benefit of Warfarin in Patients With Atrial Fibrillation: A Report From the Swedish Atrial Fibrillation Cohort Study

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Friberg, Leif, Rosenqvist, Mårten, Lip, Gregory Y.H.·2012·Circulation

DOI 10.1161/circulationaha.111.055079

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Abstract

Background—: Known risk factors for bleeding during anticoagulant treatment are largely the same as those predicting thromboembolic events in patients with atrial fibrillation (AF). Our objective was to investigate how to maximize the likelihood of avoiding both stroke and bleeding. Methods and Results—: All 182 678 subjects with atrial fibrillation in the Swedish Hospital Discharge Register were studied for an average of 1.5 years (260 000 patient-years at risk). Patients were stratified according to risk scores with the use of historic International Classification of Disease diagnostic codes in the register. Information about medication was obtained from the Swedish Drug Registry. Our primary end point was net benefit defined as number of avoided ischemic strokes with anticoagulation minus the number of excess intracranial bleedings with a weight of 1.5 to compensate for the generally more severe outcome with intracranial bleedings. The adjusted net clinical benefit favored anticoagulation for almost all atrial fibrillation patients. The exceptions were patients at very low risk of ischemic stroke with a CHA 2 DS 2 -VASc score of 0 and moderately elevated bleeding risk (−1.7%/y). The results were broadly similar with CHADS 2 , except for patients with very low embolic risk; the CHA 2 DS 2 -VASc was able to identify those patients (n=6205, 3.9% of all patients) who had no net clinical benefit or even some disadvantage from anticoagulant treatment. Conclusions—: In almost all patients with atrial fibrillation, the risk of ischemic stroke without anticoagulant treatment is higher than the risk of intracranial bleeding with anticoagulant treatment. Analysis of the net benefit indicates that more patients may benefit from anticoagulant treatment.

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Authors: Friberg, L., Rosenqvist, M., & Lip, G. Y. H.
Affiliations: Birmingham City Hospital (GB)
Danderyds sjukhus (SE)
ORCID: Friberg, Leif
Rosenqvist, Mårten
Lip, Gregory Y.H.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2012-05-15
Volume: 125
Issue: 19
Pages: 2298-2307
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/circulationaha.111.055079
OpenAlex: W2165762371
Cited by: 454
References: 38
Citations by year: 2026: 9 · 2025: 15 · 2024: 9 · 2023: 14 · 2022: 16 · 2021: 28 · 2020: 31 · 2019: 33 · 2018: 26 · 2017: 30 · 2016: 57 · 2015: 50 · 2014: 54 · 2013: 57 · 2012: 24
FWCI: 38.08
Type: journal article
Language: en
Open access: green
research.birmingham.ac.uk
Licence: other-oa
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
Keywords: atrial fibrillation, warfarin, anticoagulation, net clinical benefit, ischemic stroke, intracranial hemorrhage, CHA2DS2-VASc score, CHADS2 score, stroke risk stratification, bleeding risk, hospital discharge registry
MeSH terms: Aged, Anticoagulants, Atrial Fibrillation, Cerebral Hemorrhage, Female, Follow-Up Studies, Humans, Male, Middle Aged, Registries, Risk Factors, Sweden, Warfarin, Cohort Studies, Incidence, Stroke, Intracranial Embolism

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Net Clinical Benefit of Warfarin in Patients With Atrial Fibrillation: A Report From the Swedish Atrial Fibrillation Cohort Study

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