We appreciate Portnoi's insights into the importance of thoughtful and careful decision making for elderly individuals. Our findings1 agree with her perception that anticoagulant therapy for stroke prevention with atrial fibrillation is underused among elderly patients. We sought to uncover the patterns of this underuse and found that a substantial portion remains unexplained, even when all potential contraindications are considered.
Brass LM, Krumholz HM, Scinto JD, Mathur D, Radford M. The Underuse of Warfarin Treatment in the Elderly. Arch Intern Med. 1999;159(12):1374–1375. doi: