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Stroke Prevention Guidelines
- David B. Matchar, MD
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
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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 Unpublished letters cannot be returned.
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IN RESPONSE:
Recent clinical trials, including SPAF, have shown that anticoagulation with warfarin sodium can reduce the risk for stroke in patients with atrial fibrillation. As stated in our review, this relative risk reduction may not be worth the risks attendant to anticoagulation in patients in whom the absolute risk is small [1].
The crucial question is, who has a small absolute risk? The answer has been, and continues to be, a moving target. Indeed, since the submission of our manuscript, a pooled analysis by the Atrial Fibrillation Investigators has shown that persons with lone atrial fibrillation had a relatively low risk for stroke at any age [2]. One caveat is that these data were derived not from a population-based survey but rather from the experience of volunteers in a clinical trial. The risk for stroke in a more representative population of older persons with lone atrial fibrillation could be considerably higher.
Despite this caveat, we agree that the recent results support recommendations for using anticoagulation to treat atrial fibrillation less on the basis of age than on that of clinical characteristics. We look forward to the eventual validation of echocardiographic risk factors (not available to the Atrial Fibrillation Investigators) so that clinicians can better identify persons who can postpone or avoid anticoagulation.
David B. Matchar
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
