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Underuse of Warfarin in Atrial Fibrillation

Tsung O. Cheng, MD
Arch Intern Med. 1997;157(13):1505. doi:10.1001/archinte.1997.00440340149016.
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The sobering article by Albers et al1 about the significant underuse of antithrombotic therapy for patients with atrial fibrillation in university hospitals highlights "the conundrum of anticoagulation for atrial fibrillation."2 The efficacy of warfarin sodium therapy for stroke prevention in patients with atrial fibrillation, either valvular or nonvalvular in origin, has been well documented in multiple clinical trials.3 So, why, then, is antithrombotic therapy still underused?

One of the reasons may be that there is a knowledge gap about the risks and benefits of warfarin therapy, as has been pointed out recently in several articles,4-7 including 2 that were published in the Archives.6,7 However, the fact that the study by Albers and colleagues was carried out in academic hospitals tends to disprove this theory.

Another possible reason is the demanding nature of warfarin therapy.2 Frequent office visits are required to monitor the patients' prothrombin


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