This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (66)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Arrhythmias  • Alert me on articles by topic

Malcolm Man-Son-Hing, MD, MSc, FRCPC; Graham Nichol, MD, MPH, FRCPC; Anita Lau; Andreas Laupacis, MD, MSc, FRCPC

Arch Intern Med. 1999;159:677-685.

Objective  To determine whether the risk of falling (with a possible increased chance of subdural hematoma) should influence the choice of antithrombotic therapy in elderly patients with atrial fibrillation.

Design  A Markov decision analytic model was used to determine the preferred treatment strategy (no antithrombotic therapy, long-term aspirin use, or long-term warfarin use) for patients with atrial fibrillation who are 65 years of age and older, are at risk for falling, and have no other contraindications to antithrombotic therapy. Input data were obtained by systematic review of MEDLINE. Outcomes were expressed as quality-adjusted life-years.

Results  For patients with average risks of stroke and falling, warfarin therapy was associated with 12.90 quality-adjusted life-years per patient; aspirin therapy, 11.17 quality-adjusted life-years; and no antithrombotic therapy, 10.15 quality-adjusted life-years. Sensitivity analysis demonstrated that, regardless of the patients' age or baseline risk of stroke, the risk of falling was not an important factor in determining their optimal antithrombotic therapy.

Conclusions  For elderly patients with atrial fibrillation, the choice of optimal therapy to prevent stroke depends on many clinical factors, especially their baseline risk of stroke. However, patients' propensity to fall is not an important factor in this decision.

From the Department of Medicine, University of Ottawa (Drs Man-Son-Hing, Nichol, and Laupacis), and the Clinical Epidemiology Unit (Drs Man-Son-Hing, Nichol, and Laupacis and Ms Lau) and Geriatric Assessment Unit (Dr Man-Son-Hing), Ottawa Hospital, Ottawa, Ontario. Dr Nichol is a Career Scientist of the Ontario Ministry of Health. Dr Laupacis is a Career Scientist of the Medical Research Council of Canada.

RELATED ARTICLE

Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 1999;159(7):760-761.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Review: Stroke prevention: modifying risk factors
Romero et al.
Therapeutic Advances in Cardiovascular Disease 2008;2:287-303.
ABSTRACT  

Use of Anticoagulation in Elderly Patients with Atrial Fibrillation Who Are at Risk for Falls
Garwood and Corbett
The Annals of Pharmacotherapy 2008;42:523-532.
ABSTRACT | FULL TEXT  

'Rules of thumb' or reflective practice? Understanding senior physicians' decision-making about anti-thrombotic usage in atrial fibrillation
Anderson et al.
QJM 2007;100:263-269.
ABSTRACT | FULL TEXT  

Safety of Oral Anticoagulation in Elderly Atrial Fibrillation Patients to Prevent Strokes
Stollberger et al.
Stroke 2006;37:1960-1961.
FULL TEXT  

Comparison of Bleeding in Patients With Nonvalvular Atrial Fibrillation Treated With Ximelagatran or Warfarin: Assessment of Incidence, Case-Fatality Rate, Time Course and Sites of Bleeding, and Risk Factors for Bleeding.
Douketis et al.
Arch Intern Med 2006;166:853-859.
ABSTRACT | FULL TEXT  

Barriers to using warfarin in non-valvular atrial fibrillation.
Gattellari et al.
BMJ 2006;332:303-304.
FULL TEXT  

Prognostic Implications of Warfarin Cessation After Major Trauma: A Population-Based Cohort Analysis
Hackam et al.
Circulation 2005;111:2250-2256.
ABSTRACT | FULL TEXT  

Effect of Intensity of Oral Anticoagulation on Stroke Severity and Mortality in Atrial Fibrillation
Hylek et al.
NEJM 2003;349:1019-1026.
ABSTRACT | FULL TEXT  

Predictors of Warfarin Use Among Ohio Medicaid Patients With New-Onset Nonvalvular Atrial Fibrillation
Johnston et al.
Arch Intern Med 2003;163:1705-1710.
ABSTRACT | FULL TEXT  

Anticoagulant-Related Bleeding in Older Persons With Atrial Fibrillation: Physicians' Fears Often Unfounded
Man-Son-Hing and Laupacis
Arch Intern Med 2003;163:1580-1586.
ABSTRACT | FULL TEXT  

Can Patients Be Anticoagulated After Intracerebral Hemorrhage?: A Decision Analysis
Eckman et al.
Stroke 2003;34:1710-1716.
ABSTRACT | FULL TEXT  

Prevalence of Atrial Fibrillation and Antithrombotic Prophylaxis in Emergency Department Patients
Scott et al.
Stroke 2002;33:2664-2669.
ABSTRACT | FULL TEXT  

New Evidence for Stroke Prevention: Clinical Applications
Straus et al.
JAMA 2002;288:1396-1398.
ABSTRACT | FULL TEXT  

Balancing the Risks of Stroke and Upper Gastrointestinal Tract Bleeding in Older Patients With Atrial Fibrillation
Man-Son-Hing and Laupacis
Arch Intern Med 2002;162:541-550.
ABSTRACT | FULL TEXT  

The Effect of Perioperative Aspirin Therapy in Peripheral Vascular Surgery: A Decision Analysis
Neilipovitz et al.
Anesth. Analg. 2001;93:573-580.
ABSTRACT | FULL TEXT  

Why aren't we falling for anticoagulant therapy?
Man-Son-Hing
CMAJ 2000;162:191-191.
FULL TEXT  

Warfarin Use among Ambulatory Patients with Nonvalvular Atrial Fibrillation: The AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study
Go et al.
ANN INTERN MED 1999;131:927-934.
ABSTRACT | FULL TEXT  

State-of-the-Art Review: Warfarin Therapy: A Review of the Literature Since the Fifth American College of Chest Physicians' Consensus Conference on Antithrombotic Therapy
Lodwick
CLIN APPL THROMB HEMOST 1999;5:208-215.