TREMENDOUS STRIDES have been made in the last 10 years in the prevention of ischemic stroke due to atrial fibrillation (AF). A series of randomized controlled trials have shown that warfarin therapy, targeting an international normalized ratio (INR) range of 2.0 to 3.0, can reduce the incidence of stroke by 64% to 87%,1- 5 that warfarin is better than aspirin in select groups,6 and that patients with AF can be stratified into high- and low-risk categories to better define optimal therapy.7 Importantly, the benefit of anticoagulation therapy far outweighs the risk of major hemorrhage, the principal adverse effect of anticoagulants. But does it? The study by Samsa et al8 in this issue of the ARCHIVES suggests that there may be problems with the everyday management of oral anticoagulation that may lead to different outcomes than those experienced in the large randomized studies.
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