The American Journal of Medicine
Volume 120, Issue 8 , Pages 700-705 , August 2007

Death and Disability from Warfarin-Associated Intracranial and Extracranial Hemorrhages

  • Margaret C. Fang, MD, MPH

      Affiliations

    • The Department of Medicine, University of California, San Francisco, Calif
    • Corresponding Author InformationRequests for reprints should be addressed to Margaret C. Fang, MD, MPH, Department of Medicine, Hospitalist Group, University of California, San Francisco, 533 Parnassus Ave, Box 0131, San Francisco, CA 94143.
  • ,
  • Alan S. Go, MD

      Affiliations

    • The Department of Medicine, University of California, San Francisco, Calif
    • Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif
    • Division of Research, Kaiser Permanente of Northern California, Oakland, Calif
  • ,
  • Yuchiao Chang, PhD

      Affiliations

    • Clinical Epidemiology Unit, Massachusetts General Hospital, Boston, Mass
  • ,
  • Elaine M. Hylek, MD, MPH

      Affiliations

    • General Internal Medicine and Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Mass.
  • ,
  • Lori E. Henault, MPH

      Affiliations

    • General Internal Medicine and Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Mass.
  • ,
  • Nancy G. Jensvold, MPH

      Affiliations

    • Division of Research, Kaiser Permanente of Northern California, Oakland, Calif
  • ,
  • Daniel E. Singer, MD

      Affiliations

    • Clinical Epidemiology Unit, Massachusetts General Hospital, Boston, Mass

References 

  1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983–988
  2. Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. Arch Intern Med. 1994;154:1449–1457
  3. European Atrial Fibrillation Trial Study Group. Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and recent cerebral ischemia. N Engl J Med. 1995;333:5–10
  4. Hylek EM, Go AS, Chang Y, et al. Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med. 2003;349:1019–1026
  5. Gage BF, Boechler M, Doggette AL, et al. Adverse outcomes and predictors of underuse of antithrombotic therapy in medicare beneficiaries with chronic atrial fibrillation. Stroke. 2000;31:822–827
  6. Brass LM, Krumholz HM, Scinto JM, Radford M. Warfarin use among patients with atrial fibrillation. Stroke. 1997;28:2382–2389
  7. Fang MC, Stafford RS, Ruskin JN, Singer DE. National trends in antiarrhythmic and antithrombotic medication use in atrial fibrillation. Arch Intern Med. 2004;164:55–60
  8. Bungard TJ, Ghali WA, Teo KK, et al. Why do patients with atrial fibrillation not receive warfarin?. Arch Intern Med. 2000;160:41–46
  9. Go AS, Hylek EM, Borowsky LH, et al. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study. Ann Intern Med. 1999;131:927–934
  10. Go AS, Hylek EM, Chang Y, et al. Anticoagulation therapy for stroke prevention in atrial fibrillation: how well do randomized trials translate into clinical practice?. JAMA. 2003;290:2685–2692
  11. Bamford J, Sandercock P, Dennis M, et al. A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project 1981-1986. J Neurol Neurosurg Psychiatry. 1990;53:16–22
  12. Arellano MG, Petersen GR, Petitti DB, Smith RE. The California Automated Mortality Linkage System (CAMLIS). Am J Public Health. 1984;74:1324–1330
  13. Hylek E, Singer D. Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med. 1994;120:897–902
  14. Berwaerts J, Dijkhuizen RS, Robb OJ, Webster J. Prediction of functional outcome and in-hospital mortality after admission with oral anticoagulant-related intracerebral hemorrhage. Stroke. 2000;31:2558–2562
  15. Fang MC, Chang Y, Hylek EM, et al. Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med. 2004;141:745–752
  16. Gage BF, Birman-Deych E, Kerzner R, et al. Incidence of intracranial hemorrhage in patients with atrial fibrillation who are prone to fall. Am J Med. 2005;118:612–617
  17. Torn M, Bollen WLEM, van der Meer FJM, et al. Risks of oral anticoagulant therapy with increasing age. Arch Intern Med. 2005;165:1527–1532
  18. DiMarco JP, Flaker GC, Waldo AL, et al. Factors affecting bleeding risk during anticoagulant therapy in patients with atrial fibrillation: observations from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Study. Am Heart J. 2005;149:650–656
  19. Devereaux PJ, Anderson DR, Gardner MJ, et al. Differences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation: observational study. BMJ. 2001;323:1218–1222
  20. Hart R, Pearce L, McBride R, et al. Factors associated with ischemic stroke during aspirin therapy in atrial fibrillation: analysis of 2012 participants in the SPAF I-III clinical trials. Stroke. 1999;30:1223–1229
  21. Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001;285:2864–2870
  22. Wang TJ, Massaro JM, Levy D, et al. A risk score for predicting stroke or death in individuals with new-onset atrial fibrillation in the community: the Framingham Heart Study. JAMA. 2003;290:1049–1056
  23. Singer DE, Albers GW, Dalen JE, et al. Antithrombotic therapy in atrial fibrillation: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126:429S–456S
  24. Fang MC, Go AS, Hylek EM, et al. Age and the risk of warfarin-associated hemorrhage: the anticoagulation and risk factors in atrial fibrillation study. J Am Geriatr Soc. 2006;54:1231–1236
  25. Rosand J, Eckman MH, Knudsen KA, et al. The effect of warfarin and intensity of anticoagulation on outcome of intracerebral hemorrhage. Arch Intern Med. 2004;164:880–884
  26. O’Donnell H, Rosand J, Knudsen K, et al. Apolipoprotein E genotype and the risk of recurrent lobar intracerebral hemorrhage. N Engl J Med. 2000;342:240–245
  27. Rosand J, Hylek EM, O’Donnell HC, Greenberg SM. Warfarin-associated hemorrhage and cerebral amyloid angiopathy. Neurology. 2000;55:947–957
  28. Hart RG, Tonarelli SB, Pearce LA. Avoiding central nervous system bleeding during antithrombotic therapy: recent data and ideas. Stroke. 2005;36:1588–1593
  29. Chiquette E, Amato M, Bussey H. Comparison of an anticoagulation clinic with usual medical care. Arch Intern Med. 1998;158:1641–1647
  30. Fitzmaurice D, Hobbs R, Murray E, et al. Oral anticoagulation management in primary care with the use of computerized decision support and near-patient testing. Arch Intern Med. 2000;160:2343–2348

 This work was supported by Public Health Services research grant AG15478 from the National Institute on Aging, the Eliot B. and Edith C. Shoolman Fund of Massachusetts General Hospital, and a Hartford Geriatrics Health Outcomes Research Scholars Award from the AGS Foundation for Health in Aging.

PII: S0002-9343(06)01022-9

doi: 10.1016/j.amjmed.2006.07.034

The American Journal of Medicine
Volume 120, Issue 8 , Pages 700-705 , August 2007