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Stroke Prevention Guidelines
- Robert G. Hart, MD;
- William M. Feinberg, MD; and
- Jonathan L. Halperin, MD
- For the SPAF Investigators, University of Texas Health Sciences Center, San Antonio, TX 78284-7883. Center for Health Policy Research and Education, Duke University, Durham, NC 27708.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
Matchar and colleagues [1] cite the Stroke Prevention in Atrial Fibrillation (SPAF) study analyses [2, 3] to support the claim that “patients younger than 60 years who have a normal echocardiogram and no risk factors have an extremely low risk for stroke (1% per year).” Because the prevalence of atrial fibrillation is strongly related to advanced patient age, this scheme suggests that fewer than 5% of approximately 2 million Americans with atrial fibrillation would be at low risk. We reported that patients of any age with atrial fibrillation and without specific clinical or echocardiographic risk factors have a relatively low risk for ischemic stroke [3]. Such patients composed 26% of our study cohort and may represent an even larger portion of patients not enrolled in clinical trials [3].
Warfarin is more effective than aspirin in preventing ischemic stroke in patients with atrial fibrillation as a group (relative risk reduction, 47%; 95% CI, 28% to 61%) [4]. We contend, however, that anticoagulation therapy can be deferred for many patients with atrial fibrillation and a low intrinsic risk for stroke. These patients may benefit little from anticoagulation when absolute rates are considered (Table 1). The clinical risk stratifiers derived by analyses of patients in the SPAF study given placebo have been validated in other cohorts [4, 5]. Collaborative analysis of five primary prevention trials yielded similar, perhaps more generalizable, stratification variables. The ongoing SPAF III study is attempting to define additional subgroups of patients with atrial fibrillation who can be maintained at low risk with aspirin and for whom the need for lifelong anticoagulation may be reasonably postponed.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
