I would like to comment on 2 articles dealing with anticoagulant treatment in patients with atrial fibrillation that were recently published in the Archives.
Schlicht et al1 examined physicians' adherence to the recommendations of the American College of Chest Physicians concerning anticoagulant treatment in atrial fibrillation. One of their parameters of nonadherence was the failure to overlap heparin with warfarin for the recommended period. However, the recommendations for the heparin and warfarin overlap quoted by the authors concern anticoagulation in venous thromboembolism.2 I am not aware of such a guideline in the case of anticoagulant treatment for atrial fibrillation, and the very same recommendations that Schlicht and colleagues cite do not mention the need for heparin.2 Indeed, there is a difference in the pathophysiological mechanisms that prevail in the 2 conditions. In venous thromboembolism, there is already evidence of a formed thrombus or a pulmonary embolus, with
Liron M. Anticoagulation for Atrial Fibrillation. Arch Intern Med. 1996;156(16):1895-1899. doi:10.1001/archinte.1996.00440150161022