Management of atrial fibrillation

摘要

In their Review on the management of atrial fibrillation, Gregory Lip and Hung-Fat Tse state that "there is a strong argument to use anticoagulation more often in the absence of contraindication" and that patients at "high risk" of bleeding include elderly people and those with a history of bleeding. However, studies showthatthese factors are not barriers to anticoagulant use.Anticoagulant underuse is partly due to a misperception of risks. Elderly people are least likely to receive anticoagulation but are at most risk of stroke. A "fall risk", for example, all too often presents a therapeutic dilemma. Elderly patients who fall do so with a mean of 1-81 falls per year.One study, however, estimated that one would need to fall about 295 times per year for warfarin to not be the optimum therapy. In another study, warfarin therapy was actually associated with lower rates of fall-related bleeds than no anticoagulant therapy. The authors of that paper concluded that "this phenomenon may lead to...the possible denial of warfarin therapy to many of those who would benefit"