IN THE PAST DECADE, definitive evidence has emerged from multiple randomized clinical trials that establishes adjusted-dose oral anticoagulants (target international normalized ratio of prothrombin time [INR], approximately 2.0-3.0) as highly effective and safe therapy for prevention of stroke in patients with atrial fibrillation.1 Since 1992, several authoritative groups, including the American College of Chest Physicians, American Heart Association, and American College of Physicians have strongly and repeatedly recommended that most patients with atrial fibrillation be prescribed adjusted-dose warfarin sodium therapy.2-5 Despite compelling data and definitive recommendations, most of these patients are not receiving oral anticoagulation therapy. Although aspirin is less effective than warfarin for stroke prevention in these patients, it continues to be commonly prescribed, and a substantial number of eligible patients with atrial fibrillation receive no antithrombotic therapy.6,7
Albers GW. Choice of Antithrombotic Therapy for Stroke Prevention in Atrial Fibrillation: Warfarin, Aspirin, or Both? Arch Intern Med. 1998;158(14):1487–1491. doi:https://doi.org/10.1001/archinte.158.14.1487
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