Drug Can Prevent 40,000 Strokes a Year, Study Says : Health: Federal agency recommends that doctors increase use of warfarin, a common anticoagulant.

The increased use of a common drug could prevent an estimated 40,000 strokes annually but many physicians are reluctant to prescribe it, federal health officials said Thursday.

The drug, warfarin, an anticoagulant also known by the brand name Coumadin, could prevent half of the 80,000 strokes that occur in Americans suffering from atrial fibrillation, according to the Agency for Health Care Policy and Research.

Atrial fibrillation, which afflicts an estimated 5% of all Americans older than 65, is a condition in which the heart beats rapidly and erratically, causing blood clots that can result in stroke.

Stroke--when blood flow to the brain is blocked--strikes more than half a million Americans annually and is the third-leading cause of death after heart disease and cancer. It is the leading cause of disability in adults.

The single biggest risk factor for stroke is high blood pressure. Diabetes, smoking, obesity and excessive alcohol intake can also contribute to stroke.

Researchers said many primary-care physicians “underuse” warfarin, a blood thinner, because they are not aware of the techniques for administering the drug safely and are afraid of causing bleeding.

However, “when properly administered, we estimate that for every major bleeding complication it causes, the drug prevents 20 strokes and deaths,” said Dr. David B. Matchar of Duke University, the principal investigator of the government-sponsored stroke-prevention patient outcomes research team, a five-year study sponsored by the agency to develop recommendations for stroke prevention.

Researchers said aspirin also can be used but it has been found to be less effective than warfarin, which is also used in rat poison.

The study is not yet completed but the agency took the unusual step of releasing this information early because of its potential to save lives, officials said.

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“We feel these findings can have such a profound effect on the lives of people at risk for stroke that we couldn’t wait until this study finished next year,” said Clifton R. Gaus, the agency’s administrator.

Some doctors refuse to use the drug because it requires regular monitoring, which potentially is a big demand on physicians’ time, the agency said. But the monitoring can be conducted by nurses or physician assistants under a doctor’s supervision or through routine lab work, the agency said.

The agency estimated that the appropriate preventive treatment could save about $600 million every year, most of this in follow-up care for stroke patients.

In another area of stroke prevention, the study found that carotid endarterectomy, a surgical procedure that removes fatty plaque from arteries that carry blood from the heart to the brain, is “beneficial and cost-effective” for those with a high degree of blockage and who have major risk factors for stroke.

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But the researchers suggested that the procedure, which carries its own risks, might be overused and recommended that it not be performed on those without such symptoms.

“The risk of confirmatory testing and surgery, and the high cost of screening a large number of asymptomatic individuals would outweigh the benefits to the small number of surgical candidates identified,” Matchar said.

The agency, which was created by Congress in 1989 to evaluate standards of care for medical practice with an eye toward reducing health care costs, may be facing its own survival crisis. The GOP has recommended slashing its $162-million budget by more than half, which agency officials have said would be virtually the same as eliminating it.