We read with interest the review article by Bungard et al1 recently published in the ARCHIVES. The authors reported that the most common reason for warfarin underuse is probably the clinical perception of patients' noncompliance with anticoagulant therapy, although most studies have undervalued this reason.1
Of 1227 patients consecutively admitted in the last 2 years to our Acute Care for the Elderly Unit, 138 had chronic atrial fibrillation (established arrhythmia lasting at least 6 months) and 27 had nondatable atrial fibrillation (arrhythmia with onset lasting more than 48 hours but less than 6 months). Of these, 20 patients at low risk of stroke received aspirin because they did not meet Stroke Prevention in atrial fibrillation eligibility criteria for anticoagulation,2,3 and 18 received neither warfarin nor aspirin because of severe clinical contraindications (6 with recent gastrointestinal bleeding, 4 with child C hepatic cirrhosis, 4 with end-stage malignancy, and 4 with pleural effusion). Among the remaining 127 patients, 58 received warfarin and 69 aspirin on the basis of the clinical perception at discharge of their inability to comply with anticoagulant therapy.
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