BMJ 1996;312:51 (6 January)

Letters

Many patients are ineligible

EDITOR,--I share C M Sudlow and colleagues' concern over whether evidence from studies of the prevention of stroke in patients with atrial fibrillation applies to clinical practice because of the highly selected nature of the patients in randomised trials.1 Compliance and safety may be different when anticoagulants are used in clinical practice rather than in the carefully selected, well motivated, and closely monitored participants in studies, and patients in clinical practice may have different risks of thromboembolism and bleeding. In a recent survey of patients with atrial fibrillation, for example, the monitoring interval was less frequent, the international normalised ratio less commonly within the target therapeutic range, and the prevalence of concurrent illness higher than was the case in patients in clinical trials.2 The concerns about translating the results of clinical trials to clinical practice do not mean, however, that we should neglect to give antithrombotic drugs, including warfarin, to . . . [Full text of this article]


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Relevant Article

How To Do It: Service provision and use of anticoagulants in atrial fibrillation
C M Sudlow, H Rodgers, R A Kenny, and R G Thomson
BMJ 1995 311: 558-560. [Extract] [Full Text]

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