Many physicians consider it ethical and sound to use anticoagulants in patients with stroke and atrial fibrillation (AF). Drs Starkey and Warlow suggest that it may be unethical and unsound to do so. They argue convincingly that no studies have been undertaken that would settle the question by today's standards. Sherman and colleagues accept the lack of convincing trials but point out that strokes occur frequently in patients with AF, mostly from cardiac embolism. The strokes tend to be severe and recurrent.
A fundamental difficulty in assessing the danger of recurrent stroke and the benefit of anticoagulant therapy is the unreliability of a clinical diagnosis of cardiac embolism. In the absence of valvular disease, the older the individual the higher the likelihood of AF and cerebrovascular disease coexisting. Among 59 patients deemed to have a possible cardiac source of emboli, 29 also had an appropriate carotid lesion that could account
Hachinski V. Atrial Fibrillation and Recurrent Stroke. Arch Neurol. 1986;43(1):70. doi:10.1001/archneur.1986.00520010064025
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