Clinical correlation between effective anticoagulants and risk of stroke: are we using evidence-based strategies?
OBJECTIVE
Despite evidence supporting anticoagulant use in atrial fibrillation, this modality is not fully utilized.


METHODS
Retrospective chart review of 297 patients with nonvalvular atrial fibrillation between 1997 to 2000. 124 patients received warfarin and 166 did not; 91 patients suffered stroke.


RESULTS
Age (P = 0.232) and gender (P = 0.745) were not determinant factors for starting anticoagulation prophylaxis. Whites were more likely to receive anticoagulation therapy than blacks (P = 0.043). Cardiologists were 4.5 times more likely to prescribe warfarin than neurologists and internists (P = 0.035). Neurologists (P = 0.305) and internists (P = 0.770) had similar warfarin prescription patterns and often with patients experiencing the highest rates of stroke.


CONCLUSIONS
Lack of a uniform pattern in anticoagulant administration, despite multiple guidelines, is disturbing. Continuous physician education and community awareness by local and federal medical agencies is essential and cost-effective.
Rahimi
Ali R
AR
Department of Internal Medicine Education, Memorial Health University Medical Center, 4700 Waters Avenue, Savannah, GA 31404 , USA.
Wrights
Bobby
B
Akhondi
Hossein
H
Richard
Christian M
CM
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005260:Female; D005845:Georgia; D006801:Humans; D019934:International Normalized Ratio; D016015:Logistic Models; D008297:Male; D008511:Medicine; D008875:Middle Aged; D012189:Retrospective Studies; D013038:Specialization; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin