Does Warfarin Initiation Transiently Increase Stroke Risk from Atrial Fibrillation?

An observational study raises the possibility of a temporary hypercoagulable state after warfarin initiation, but more data are needed to settle this question.

Initiation of warfarin therapy has long been associated with the possibility of transient hypercoagulability from depletion of anticoagulant factors. This concern is often regarded as largely theoretical, and current atrial fibrillation (AF) guidelines do not recommend bridging therapy with heparin when starting warfarin for thromboembolism prophylaxis. However, in two recent randomized trials, AF patients transitioning from blinded apixaban or rivaroxaban to open-label warfarin experienced higher rates of stroke than those continuing from blinded to open-label warfarin. To explore warfarin-induced hypercoagulability as a potential mechanism of this phenomenon, investigators performed a case-control study using data from primary care clinic…

Reviewing Author

Hooman Kamel, MD

Disclosures

Speaker’s bureauGenentech

Grant / Research supportNational Institutes of Health/National Institute of Neurological Disorders and Stroke; Michael Goldberg Stroke Research Fund

Editorial boardsPLOS One; Scientific Reports

Leadership positions in professional societiesNeurocritical Care Society (Research Committee Member)

Hooman Kamel, MD

Disclosures

Speaker’s bureauGenentech

Grant / Research supportNational Institutes of Health/National Institute of Neurological Disorders and Stroke; Michael Goldberg Stroke Research Fund

Editorial boardsPLOS One; Scientific Reports

Leadership positions in professional societiesNeurocritical Care Society (Research Committee Member)

Does Warfarin Initiation Transiently Increase Stroke Risk from Atrial Fibrillation?

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Reviewing Author