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Anticoagulation for patients with atrial fibrillation and risk factors for stroke

BMJ 2000; 320 doi: (Published 06 May 2000) Cite this as: BMJ 2000;320:1219

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

  1. Stuart J Connolly, professor of medicine (
  1. McMaster University, Hamilton, Ontario, Canada L8L 2X2

    Papers p 1236

    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 year) of a stroke.1 On the …

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