Authors: J David Spence
Publish Date: 2012/12/12
Volume: 120, Issue: 10, Pages: 1447-1451
Abstract
With the advent of new oral anticoagulants the place of warfarin for stroke prevention in patients with atrial fibrillation needs reevaluation Warfarin is difficult to use because of large individual differences in response and metabolism many significant interactions with drugs and foods and fluctuations in vitamin K absorption It requires frequent blood testing and dose adjustments so with good reason patients and physicians are eager for the newer agents that are easier to use However the purchase price of the new anticoagulants is so high that warfarin will remain in widespread use It is important therefore for physicians to know how to use it well Anticoagulants work much better for stroke prevention in atrial fibrillation than do antiplatelet agents physicians need to understand the concept of red thrombus for which anticoagulants are required versus white thrombus—platelet aggregates—which are the target of antiplatelet agents Stroke from atrial fibrillation increases steeply with age and the elderly benefit disproportionately from anticoagulation It is still necessary for physicians to know how to use warfarin and to use it better than it has been used in the past
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