Dr. Waldo, writing in an editorial in the August 27th issue of JAMA, comments that less than half of patients who would be good candidates for treatment with blood thinners to reduce their risk of stroke are actually receiving the drugs. Elderly patients are least likely to be treated, says Waldo, who is also a professor of medicine at Case Western Reserve University School of Medicine.
"In short, not enough patients with atrial fibrillation at recognized risk for ischemic stroke receive warfarin (Coumadin) therapy, and patients with the greatest risk of ischemic stroke in the face of atrial fibrillation are the ones who receive it least." The JAMA article suggesting a new way to "score" a patient's risk was written by Thomas J. Wang, MD, and colleagues of the Framingham Heart Study in Framingham, Mass. They developed a scoring system involving the following risk predictors: advancing age, female, increasing systolic blood pressure, prior stroke or transient ischemic attack, and diabetes. The scores can be used to "easily stratify patients at particularly high or low risk," for stroke or death, according to Dr. Wang. Once risk is properly assessed, patients can be provided appropriate counseling and/or treatment.
Patients who have been diagnosed with atrial fibrillation have a four-fold to five-fold increase in their risk of ischemic stroke (interruption of blood flow to the brain due to a clot). Warfarin or Coumadin therapy can reduce that risk by approximately 70 to 80 percent. Studies indicate that warfarin or Coumadin is much more effective than aspirin in preventing ischemic stroke.
Dr. Waldo notes that many physicians are wary of using warfarin, especially among elderly patients, because of the risk of bleeding due to falls or frailty. However, "the risk of stroke in the absence of warfarin therapy is greater than the risk of intracranial bleeding while receiving warfarin," says Waldo. Careful attention to monitoring and maintaining appropriate blood clotting factors maximizes the benefit and minimizes the risk.
University Hospitals of Cleveland and University Hospitals Health System offers a Coumadin Clinic to more than 700 patients who are regularly monitored for treatment of various disorders, including atrial fibrillation. Roche Diagnostics recently recognized the UHC Coumadin Clinic for excellence in establishing a systematic and effective approach toward managing anti-coagulation therapy.
University Hospitals Health System (UHHS) is the region's premier healthcare delivery system, serving patients at more than 150 locations throughout northern Ohio.
The System's 947-bed, tertiary medical center, University Hospitals of Cleveland (UHC), is the primary affiliate of Case Western Reserve University (CWRU). Together, they form the largest center for biomedical research in the State of Ohio. The System provides the major clinical base for translational researchers at the Case Research Institute, a partnership between UHC and CWRU School of Medicine, as well as a broad and well-characterized patient population for clinical trials involving the most advanced treatments. Included in UHC are Rainbow Babies & Children's Hospital, among the nation's best children's hospitals; Ireland Cancer Center, northern Ohio's only National Cancer Institute-designated Comprehensive Cancer Center (the nation's highest designation); and MacDonald Women's Hospital, Ohio's only hospital for women.
Committed to advanced care and advanced caring, University Hospitals Health System offers the region's largest network of primary care physicians, outpatient centers and hospitals. The System also includes a network of specialty care physicians, skilled nursing, elder health, rehabilitation and home care services, managed care and insurance programs, and the most comprehensive behavioral health services in the region.
Journal
JAMA