Prospective cohort study to determine if trial efficacy of anticoagulation for stroke prevention in atrial fibrillation translates into clinical effectiveness
Randomised controlled studies have shown that anticoagulation with adjusted warfarin dose consistently reduces the risk of stroke in patients with atrial fibrillation, yet the therapy is underused in mainstream clinical practice. In part this may be due to fears that the patients included in trials were unrepresentative of the wider patient population and the benefits of anticoagulation were thought to have been overestimated.
Lalit Kalra, professor of stroke medicine at Guy's, King's and St Thomas' School of Medicine, and colleagues conducted a two year prospective cohort study of 167 patients in a district general hospital setting to determine whether trial results translate into clinical effectiveness in practice.
The team conclude in this week's BMJ that despite differences in age, sex and anticoagulation control, the practice setting confirms the effectiveness of anticoagulation therapy and its low usage is therefore unjustified.
Contact: L Kalra, Department of medicine, Guy's, King's and St Thomas' School of Medicine, London SE5 9PJ Email: lalit.kalra@kcl.ac.uk