Atrial Fibrillation
“Lower intensity” shows promise for AF treatment
Saturday, July 1, 2006
PTINR.com Staff
How low can you go... revisited
The age-old question, “how low can you go?” while reaping the benefit of warfarin (Coumadin ®) without the unwanted risks of bleeding has once again been visited. A November 2005 article in Journal of Clinical Neuroscience suggested that lower target ranges for patients with non-valvular atrial fibrillation might be coming.
Older patients (76 +/- 7 years) were studied for 2.3 years (+/- 1.4 years) at an intensity target range of INR 1.5 to 2.5. The 63 patients were evaluated for efficacy and overall safety in an actual clinical practice. Unlike many studies more women than men participated in the two-year review.
The annual rate of stroke and systemic embolism in the practice were comparable to similar patients in clinical trials (2.0% vs. 1.4% and 0.7% vs. 0.3%). Major bleeding was also similar to large, well-controlled clinical trials (0.7% vs. 1.3%). The advantage was seen in minor bleeding events. The 63 patients in clinical practice experienced minor bleeding 3.4% of the time versus 7.9% in clinical trials.
The authors concluded that lower target ranges delivered similar efficacy and safety results as higher target ranges used in clinical trials. The small number of clinical study patients limited the study but showed promise for reducing small, nuisance bleeds commonly seen with older patients on warfarin.