Is quality of anticoagulation a 'wild card' in the treatment of patients with atrial fibrillation?

Greg C Flaker

This article has no abstract so we have provided the first paragraph of the full text.

The term 'wild card' was originally used in card games and referred to an unknown or unpredictable factor that could greatly influence the outcome of the game. Understanding this term is important when interpreting the results of the article by DeWilde and coworkers. This study analyzed information from DIN-LINK, a computerized database of patient data collected by physician practices in the UK. The prevalence of AF was found to have increased during the 10-year study period, which is not surprising. The use of anticoagulation therapy also increased during this time, almost certainly because of compelling data from randomized trials demonstrating the effectiveness of warfarin in the prevention of stroke in patients with AF. By 2003, however, only 53% of men and 40% of women with AF were receiving anticoagulation. The results are similar to the findings of a large, US-based database study performed from 1996 to 1997, which showed that only 55% of ambulatory patients with AF were receiving warfarin.¹ DeWilde et al. note that more men received anticoagulation than women, a result also reported in the US study. The big surprise was the fact that only 56.5% of patients at very high risk of stroke, compared with 38.2% of patients considered at low risk for stroke, were receiving anticoagulation.

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