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Warfarin for non-valvar atrial fibrillation: still underused in the 21st century?
  1. S Bo1,
  2. G Ciccone2,
  3. L Scaglione1,
  4. C Taliano1,
  5. M Piobbici2,
  6. F Merletti2,
  7. G Pagano1
  1. 1Department of Internal Medicine, University of Torino, Italy
  2. 2Unit of Cancer Epidemiology, S Giovanni Battista Hospital and University of Torino, Italy
  1. Correspondence to:
    Dr Simona Bo, Dipartimento di Medicina Interna, Università di Torino, Corso Dogliotti 14, 10126 Torino, Italy;

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Atrial fibrillation (AF) is associated with an increased risk of stroke, particularly in the elderly.1 Warfarin is associated with a 70% relative risk reduction of stroke compared with placebo, with only a moderate increase of major bleeding. Warfarin is more beneficial than aspirin for patients at higher risk from thromboembolism (stroke rate > 6%/year), but offers only modest protection compared with aspirin in patients at lower risk (stroke rate ≤ 2%/year).

Guidelines recommend that patients with non-valvar AF and higher stroke risk should be treated with warfarin.1,2 Nevertheless, in clinical practice the drug is underused.3 Most previous studies on the appropriateness of warfarin were performed before 1995, only a few years after publication of the randomised stroke prevention trials and thus without a sufficient time lag to incorporate their results into practice.

Our study was designed to assess the current appropriateness of antithrombotic treatment for patients with AF discharged from a teaching hospital in Turin, Italy.


We identified 313 consecutive patients with chronic AF as a secondary diagnosis (International classification of diseases, ninth revision, clinical modifications, diagnosis code 427.31) from the discharge file of S Giovanni Battista Hospital of Turin during the six month period from 1 January to 30 June 2000.

Exclusion criteria were: (1) AF as main diagnosis, since cardioversion should be considered and anticoagulation employed according to a specific protocol1; (2) mitral stenosis or a prosthetic heart valve, because anticoagulant treatment is standard; (3) age > 90 years; (4) discharges from surgical units, because of contraindications …

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