Pro: 'Warfarin should be the drug of choice for thromboprophylaxis in elderly patients with atrial fibrillation'. Why warfarin should really be the drug of choice for stroke prevention in elderly patients with atrial fibrillation.

摘要

As is well recognised, warfarin is the most effective agent that is available in clinical practice for preventing the thromboembolic sequelae of atrial fibrillation (AF), particularly stroke (1, 2). In theory, this makes warfarin a particularly cost-effective agent for treating elderly people with AF: risks of stroke in atrial fibrillation increase with age, so fewer people need to be treated to prevent a stroke (3). However, in everyday clinical practice, the majority of elderly people in AF are not treated with warfarin (4). This partly reflects physician concern over risks of serious haemorrhage in this age group, the difficulty maintaining good international normalised ratio (INR) control, and poor adherence with therapy by patients (4). In this article, I will use the findings of the recently published Birmingham Atrial Fibrillation Treatment of the Aged Study (BAFTA) trial (5) to argue that the risks of warfarin in general are over-estimated in elderly patients, and that warfarin should really bethe drug of choice for thromboprophylaxis in elderly patients in AF.