Does warfarin (target INR 2.0 to 3.0) prevent systemic emboli in patients with dilated cardiomyopathy and sinus rhythm without left ventricular thrombus?
This article uses a clinical scenario of a patient with dilated cardiomyopathy in sinus rhythm to illustrate how to search the medical literature for evidence on anticoagulation.
Y o u are the attending physician on an inpatient service where a 51-year-old man is admitted with congestive heart failure o f recent onset. You find he has a dilated cardiomyopathy, the cause o f which remains unknown after a thorough evaluation. He is in sinus rhythm. The team's resident asks you whether the patient should be anticoagulated with warfarin, enough to keep his international normalized ratio from 2.0 t o 3.0, in order to prevent systemic emboli, even though his echocardiogram does not show left ventricular thrombus. You are not sure about the evidence concerning this issue, so you admit your shared knowledge gap and resolve t o search together for the relevant information.
Andrew D Oxman (Wed,) studied this question.