Warfarin for Dilated Cardiomyopathy: A Bloody Tough Pill to Swallow?

Joel Tsevat, Mark H. Eckman, Robert A. McNutt, Stephen G. Pauker

Research output: Contribution to journalArticle

42 Scopus citations

Abstract

Although current recommendations for the treatment of dilated cardiomyopathy include long- term anticoagulation to diminish the likelihood of systemic embolization, there have been no clinical trials examining the effectiveness of anticoagulation in preventing systemic emboli zation in these patients. Furthermore, those recommendations do not address the issue of the quality of life associated with long-term warfarin therapy. Using decision analysis, the authors examined the benefits and risks of long-term anticoagulation for patients 35 to 75 years of age who have dilated cardiomyopathy. The results show that anticoagulant therapy increases quality-adjusted life expectancy by 76 to 128 days, depending on the patient's age. Sensitivity analysis, however, demonstrates that the outcome is dependent on the disutility associated with long-term warfarin therapy. Interestingly, anticoagulation exerts most of its benefit by preventing pulmonary embolization, not systemic embolization. The authors conclude that the current recommendation to anticoagulate these patients, although probably correct for many patients, should take into consideration the change in lifestyle imposed by long-term anticoagulant therapy. For some patients, the benefit may not outweigh the sac rifice.

Original languageEnglish (US)
Pages (from-to)162-169
Number of pages8
JournalMedical Decision Making
Volume9
Issue number3
DOIs
StatePublished - Aug 1989
Externally publishedYes

Keywords

  • Key words: Anticoagulation
  • decision analysis
  • dilated cardiomyopathy
  • quality of life. (Med Decis Making 1989;9:162-169)
  • warfarin

ASJC Scopus subject areas

  • Health Policy

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