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Managing atrial fibrillation in elderly people

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7191.1088 (Published 24 April 1999) Cite this as: BMJ 1999;318:1088

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Managing atrial fibrillation in elderly people

Editor

We were interested to read English and Channer`s paper on managing
atrial fibrillation in the elderly 1. They suggest that using new low dose
starting regimens, such as that tested by Oates et al, 2 may facilitate
initiation of warfarin treatment in the community.

The Cumbria Practice Research Group is carrying out a study on atrial
fibrillation in the community, which includes initiating warfarin at 1mg
daily with weekly measurements of the International Normalized Ratio
(INR). The dose is increased in 1mg increments weekly until the target INR
is reached. The method proves to be easy to administer and avoids the
large swings in INR which sometimes occur when using the older method of
'loading doses' of warfarin. The study is still in progress and the full
results will be reported later. We did not have the benefit of Oates et
al's paper when planning the study, but their information is helpful
because their method may achieve the final dose of warfarin more quickly
than our method. This is all good news if it encourages more doctors to
initiate warfarin treatment in those at risk of stroke from atrial
fibrillation.

Eleri Roderick
General Practitioner

Jim Cox
General Practitioner

The Surgery
Caldbeck
Wigton
Cumbria CA7 8DS

1 English KM, Channer KS. Managing atrial fibrillation in elderly
people. BMJ 1999;318:1089-90.
2 Oates A, Jackson PR, Austin CA, Channer KS. A new regimen for starting
warfarin therapy in out-patients. Br J Clin Pharmacol 1998;46:157-61.

Competing interests: No competing interests

07 May 1999
Eleri Roderick