Heart 1999;82:539-540 ( November )

Editorial

Warfarin in atrial fibrillation: underused in the elderly, often inappropriately used in the young

The first 150 words of the full text of this article appear below.

In the past decade, much has been learned about antithrombotic prophylaxis to prevent stroke in patients with non-valvar atrial fibrillation (AF). Adjusted dose warfarin is highly efficacious, aspirin is modestly efficacious (reducing primarily non-disabling, non-cardioembolic strokes in AF), warfarin is much more efficacious than aspirin, and low intensity warfarin (international normalised ratios (INR) < 1.5) alone or combined with aspirin offers minimal protection.¹ The absolute risk of stroke varies widely in patients with AF, from < 1% to 12% per year, depending on age and coexisting vascular disease.^2 3 Selection of antithrombotic prophylaxis should consider the inherent risk of stroke and the absolute risk reductions afforded. It is my view that many AF patients, including most younger than 75 years, do not substantially benefit from treatment with adjusted dose warfarin.

Two observational studies in this issue address this important, controversial issue.^4 5 Perez and colleagues surveyed a sample of patients with AF randomly drawn from . . . [Full text of this article]

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