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December 8, 1997

Warfarin Therapy in the Nursing Home

Author Affiliations

Washington, DC

Arch Intern Med. 1997;157(22):2664-2665. doi:10.1001/archinte.1997.00440430146023

As a geriatrician, I read with great interest the article "Atrial Fibrillation and Stroke Prevention With Warfarin in the Long-term Care Setting," by Gurwitz et al.1 In 60% of the cases that were studied, the patients' dosing regimens were maintained above or below the recommended therapeutic range for warfarin sodium. Only 30% of patients with atrial fibrillation were receiving warfarin therapy. Yet, the authors decided against qualifying these practices as poor, because there is no "benchmark" for "optimal" or "best" practices in nursing homes. At the same time, they perpetuate the long-standing myth that warfarin therapy is affected by advanced age. To support that view, they cite 2 studies. The first study, by Hylek and Singer,2 included 121 consecutive adult patients taking warfarin who were hospitalized with intracranial hemorrhage. The age of the patients was found to be a significant independent factor for hemorrhages, but in patients with

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