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Letters |21 December 1999

Cost-Effectiveness of Therapy in Nonatrial Fibrillation

Edward Catherwood, MD, MS; Mark L. Greenberg, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • Dartmouth-Hitchcock Medical Center; Lebanon, NH 03756 (Catherwood)
    Dartmouth-Hitchcock Medical Center; Lebanon, NH 03756 (Greenberg)
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Dr. Wiesel argues that all patients with nonvalvular atrial fibrillation should receive long-term anticoagulation after successful cardioversion. He cites the frequent association of paroxysmal or chronic atrial fibrillation with acute stroke (1). He also raises concern that our estimate of early stroke risk (a 6-week fraction of the annualized risk) if relapse occurs is too low, given the potential for paroxysmal episodes. He refers to the study by Lin and colleagues (1), which examined the frequency of newly diagnosed atrial fibrillation in patients presenting with acute stroke. This study did not assess the occurrence of stroke in patients with previously detected atrial fibrillation or those with previous cardioversion. Thus, it does not address whether most patients restored to sinus rhythm, with or without prophylactic antiarrhythmic therapy, require warfarin beyond the first month after cardioversion. Furthermore, recent guidelines do not advocate long-term warfarin therapy after successful pharmacologic or electrical cardioversion unless the arrhythmia recurs or high-risk variables (that is, previous ischemic stroke and left ventricular systolic dysfunction) are present (2).
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Catherwood E, Greenberg ML. Cost-Effectiveness of Therapy in Nonatrial Fibrillation. Ann Intern Med. ;131:979. doi: 10.7326/0003-4819-131-12-199912210-00016

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Published: Ann Intern Med. 1999;131(12):979.

DOI: 10.7326/0003-4819-131-12-199912210-00016

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1999 American College of Physicians
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