Doctors and patients must decide together whether anticoagulation is appropriate

BMJ 1998;317:210 ( 18 July )

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Doctors and patients must decide together whether anticoagulation is appropriate

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

EDITOR $---$ Thomson et al suggest that variations in recommendations for anticoagulant treatment of atrial fibrillation could beovercome by having a single body responsible for producing evidencebased guidelines.¹ Might giving this responsibility to onebody lead to a form of medical tyranny in which only one viewof who should be offered anticoagulant treatment is held to bevalid? Evidence based medicine does not preclude the role of thepatient in choosing or declining a particular treatment.²

The evidence base for anticoagulant treatment of non-rheumatic atrial fibrillation is strongly influenced by just six trials,five of which have been conveniently pooled. All suggest thatanticoagulation with warfarin is beneficial. Further analysesof the data have attempted to stratify differing degrees of riskand potential benefits.³ Evidence based guidelines that couldconvey this information to clinicians would be welcome, but tosuggest that this evidence can then determine the . . . [Full text of this article]

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Relevant Article

Guidelines on anticoagulant treatment in atrial fibrillation in Great Britain: variation in content and implications for treatment: Richard Thomson, Helen McElroy, and Mark Sudlow
BMJ 1998 316: 509-513. [Abstract] [Full Text] [PDF]