BMJ 2000;320:1219-1220 ( 6 May )

Editorials

Anticoagulation for patients with atrial fibrillation and risk factors for stroke

Warfarin reduces the risk by two thirds, but doctors still aren't prescribing it enough

Papers p 1236

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

The most clinically relevant advance in the management of cardiac arrhythmia in the past two decades has been that anticoagulant treatment substantially reduces the risk of stroke in patients with atrial fibrillation. The fact that each year 4% of patients with atrial fibrillation will have a stroke prompted several randomised trials of treatment with anticoagulants that consistently reported a reduction in the incidence of strokes with warfarin. A meta-analysis of these trials shows that the risk is reduced by two thirds.¹

A subsequent analysis has shown that not all patients with atrial fibrillation have the same risk of having a stroke, and this has led to the idea of risk stratification.¹ Major risk factors for stroke are age over 75, previous stroke or transient ischaemic attack, systemic hypertension, mitral stenosis, and left ventricular dysfunction. Patients with atrial fibrillation and any of these factors face a higher than average risk (5-15% per . . . [Full text of this article]

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This article has been cited by other articles:

• Emmerich, J., Le Heuzey, J.-Y., Bath, P. M.W., Connolly, S. J. (2005). Indication for antithrombotic therapy for atrial fibrillation: reconciling the guidelines with clinical practice. Eur Heart J Suppl 7: C28-C33 [Abstract] [Full text]  
• Marshall, D. A., Levy, A. R., Vidaillet, H., Fenwick, E., Slee, A., Blackhouse, G., Greene, H. L., Wyse, D. G., Nichol, G., O'Brien, B. J., and the AFFIRM and CORE Investigators*, (2004). Cost-Effectiveness of Rhythm versus Rate Control in Atrial Fibrillation. ANN INTERN MED 141: 653-661 [Abstract] [Full text]  
• Poller, L., Keown, M., Chauhan, N., van den Besselaar, A. M., Tripodi, A., Shiach, C., Jespersen, J. (2003). Reliability of international normalised ratios from two point of care test systems: comparison with conventional methods. BMJ 327: 30- [Abstract] [Full text]  
• Rutten, F. H, Hak, E., Stalman, W. A., Verheij, T. J., Hoes, A. W (2003). Is treatment of atrial fibrillation in primary care based on thromboembolic risk assessment?. Fam Pract 20: 16-21 [Abstract] [Full text]  
• Duxbury, B. McD., Poller, L. (2001). State-of-the-Art Review: The Oral Anticoagulant Saga: Past, Present, and Future. CLIN APPL THROMB HEMOST 7: 269-275 [Abstract]  
• Fitzmaurice, D A, Mant, J, Murray, E T, Hobbs, F D R, Oswald, N., Oliver, M D, Ono, A., Bellelli, G., Bianchetti, A., Trabucchi, M. (2000). Anticoagulation to prevent stroke in atrial fibrillation. BMJ 321: 1156-1156 [Full text]  
• Dudley, N., Berry, C., McMurray, J. (2000). Anticoagulation for patients with atrial fibrillation. BMJ 321: 638-638 [Full text]  

Rapid Responses:

Read all Rapid Responses

Editorial may have overinterpreted data

Nigel Dudley
bmj.com, 8 May 2000 [Full text]

Underprescription of anti-coagulation for patients with atrial fibrillation or flutter

Colin Berry
bmj.com, 19 May 2000 [Full text]

Editorial irony?

M P H Doublet-Stewart
bmj.com, 28 May 2000 [Full text]

Restoring sinus rhythm should be the priority

S A Khan
bmj.com, 4 Jun 2000 [Full text]

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