Anticoagulation to prevent stroke in atrial fibrillation

doi:10.1136/bmj.321.7269.1156

BMJ 2000;321:1156 ( 4 November )

Letters

Anticoagulation to prevent stroke in atrial fibrillation

It's still not clear whether results in secondary care translate to primary care

Cohort was younger than many patients with atrial fibrillation in primary care

General practitioners have to decide best ways of allocating their time

Rapid anticoagulant testing is not available in general practitioners' clinics in Japan

Comprehensive geriatric evaluation should be routine before treatment is started

It's still not clear whether results in secondary care translate to primary care

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

EDITOR $---$ Kalra et al's paper looking at the efficacy of anticoagulation for stroke prevention in atrial fibrillation¹ essentiallycomplements Copland et al's work in showing that an elderly populationcan be given adequate anticoagulation.²

As Kalra et al performed a cohort study with no control population, the study does not allow any estimate of the effectivenessof the treatment as is suggested in the paper. Thus we do notknow if there was any treatment benefit. The cohort obtained similartherapeutic control to the original trial populations, but thisis not a dramatic finding given that it represents a similar population $---$ thatis, patients selected from medical outpatient clinics. This pointseems to have been lost on Connolly, who in his editorial states,"They screened 2547 patients in general practice clinics."³

As we have consistently argued, the findings of the original treatment studies and now these newer studies must be . . . [Full text of this article]

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Prospective cohort study to determine if trial efficacy of anticoagulation for stroke prevention in atrial fibrillation translates into clinical effectiveness: Lalit Kalra, Gloria Yu, Inigo Perez, Anil Lakhani, and Nora Donaldson
BMJ 2000 320: 1236-1239. [Abstract] [Full Text] [PDF]