David B. Matchar, MD
Matchar D.; Stroke Prevention Guidelines. Ann Intern Med. 1995;122:235-236. doi: 10.7326/0003-4819-122-3-199502010-00017
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Published: Ann Intern Med. 1995;122(3):235-236.
Recent clinical trials, including SPAF, have shown that anticoagulation with warfarin sodium can reduce the risk for stroke in patients with atrial fibrillation. As stated in our review, this relative risk reduction may not be worth the risks attendant to anticoagulation in patients in whom the absolute risk is small .
The crucial question is, who has a small absolute risk? The answer has been, and continues to be, a moving target. Indeed, since the submission of our manuscript, a pooled analysis by the Atrial Fibrillation Investigators has shown that persons with lone atrial fibrillation had a relatively low risk for stroke at any age . One caveat is that these data were derived not from a population-based survey but rather from the experience of volunteers in a clinical trial. The risk for stroke in a more representative population of older persons with lone atrial fibrillation could be considerably higher.
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