Warfarin for non-valvar atrial fibrillation: still underused in the 21st century?

The appropriateness of anticoagulation treatment was assessed according to three different schemes of risk stratification. 2, 4, 5 Patients were considered to have a contraindication to warfarin if any of the following were documented: haemorrhagic tendency (that is, platelets < 100000/mm3, international normalised ratio (INR) prolongation, etc); intracranial haemorrhage (history or current); major bleeding within six months (that is requiring transfusion or hospitalisation); creatinine concentration > 3.0 mg/dl (>265 μmol/l); hepatic cirrhosis; severe psychiatric disease, dementia or unreliable patient; diastolic pressure > 100 mm Hg despite antihypertensive treatment; a history of two or more falls; chronic alcoholism; allergic reaction to warfarin or previous discontinuation because of bleeding; life expectancy < 12 months; and difficulty/refusal to allow monitoring of INR values. Among 168 patients at high risk of stroke, and without contraindications to anticoagulants, warfarin use was positively associated with the number of clinical risk factors (OR 1.62, p = 0.017 for each risk factor: diabetes, coronary artery disease, previous stroke/transient ischaemic attack (TIA), hypertension, heart failure), but its use significantly declined with age (OR 0.90, p = 0.002 for each year).