VI UTVECKLAR SYSTEM FÖR SPECIALISTSJUKVÅRD

Optimal INR for prevention of stroke and death in atrial fibrillation: a critical appraisal

Abstract

Introduction: Patients with nonvalvular atrial fibrillation are at increased risk for systemic embolism, predominantly disabling stroke. To study how stroke and mortality rates vary with different degrees of anticoagulation reflected by the international normalised ratio (INR) we critically assess information from different sources.

Materials and methods:

1. Computerized search of the medical literature published between 1980 and July 2004 was performed using MEDLINE applied to various combinations of the search terms of atrial fibrillation, warfarin, anticoagulation, anticoagulation intensity, and INR, not restricted by language.

2. We performed a record linkage analysis with death hazard estimated as a continuous function of INR based on 21,967 patients. Similarly the risk of admission to hospital or death due to diseases of the vessels of the brain was estimated.

3. Re-analysis of data earlier published by Hylek et al. from year 2003.

Results and conclusions:

1. One randomised study showed a significantly lower risk of stroke for mean INR 2.4 compared to mean INR 1.3 combined with aspirin. Remaining studies found INRs of 2—2.5 to be as efficacious as higher anticoagulation intensities.

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